{"hospital_name":"Tarzana Medical Center LLC","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Providence-Cedars Sinai Tarzana Medical Center"],"hospital_address":["18321 Clark St, Tarzana, CA 91356"],"license_information":{"license_number":"930000097","state":"CA"},"type_2_npi":["1821250762"],"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":"Jessica Trimble"},"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/PPO/EPO","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":"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":"Brandman Centers","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":"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":"ChoiceCare 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":"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":"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":"Monarch Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Monarch Health Plan","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":"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":"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 DIL 12FR .038 20CM G00995","code_information":[{"code":"Px0000102227L","type":"CDM"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH HICKMAN DUAL LUMEN 13.5FR 0600662","code_information":[{"code":"Px0000104016L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":795.0,"discounted_cash":278.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH RADIAL ARTERY RA04020","code_information":[{"code":"Px0000104062L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":16.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTERCEED 3X4 4350 CDM","code_information":[{"code":"Px0000104075L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1659.0,"discounted_cash":580.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WIRE COIL PUSHER-16 M0014012160","code_information":[{"code":"Px0000115789L","type":"CDM"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GWIRE BNTSN .035 180CM G01290","code_information":[{"code":"Px0000116333L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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":245.0,"discounted_cash":85.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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":321.0,"discounted_cash":112.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 7F 25CM RSS706","code_information":[{"code":"Px0000119320L","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: JV CPCT 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":92.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":196.63,"discounted_cash":68.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PICC ARROW TWIN DL 16GA","code_information":[{"code":"Px0000121269L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.91,"discounted_cash":14.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SEPRAFILM ADHESION BARRIER 5X6 430102","code_information":[{"code":"Px0000124099L","type":"CDM"},{"code":"C1765","type":"HCPCS"}],"standard_charges":[{"gross_charge":1580.0,"discounted_cash":553.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":196.63,"discounted_cash":68.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE STIFF ANG .038 180","code_information":[{"code":"Px0000127609L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH SAFL 8.5FR 406868","code_information":[{"code":"Px0000127887L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":239.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WIRE WHOLEY .035 145CM WWIJ35145","code_information":[{"code":"Px0000128045L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC HEMOSTAT SURGCEL FIB 1X2IN 1961","code_information":[{"code":"Px0000128068L","type":"CDM"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":123.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG .035 180CM GR3508","code_information":[{"code":"Px0000128901L","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: JV CPCT 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":269.0,"discounted_cash":94.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WIRE AMPLATZ SS ST .035 180CM M001465251","code_information":[{"code":"Px0000132748L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GWIRE VASC ANG .035INX180CM GS3508","code_information":[{"code":"Px0000132914L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH INFU CRAG-MCN 5FR 100/20 4105101","code_information":[{"code":"Px0000134022L","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: JV CPCT 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":149.0,"discounted_cash":52.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH RAABE 7F 55CM G11633","code_information":[{"code":"Px0000137229L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE .025 X 35","code_information":[{"code":"Px0000137753L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WIRE BALANCE TREK .014-190CM 1005159H","code_information":[{"code":"Px0000139561L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH VISC 5FR 65CM .038 RIM G10082","code_information":[{"code":"Px0000139688L","type":"CDM"}],"standard_charges":[{"gross_charge":99.54,"discounted_cash":34.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FILTER 9FR FEMORAL NITINOL","code_information":[{"code":"Px0000140475L","type":"CDM"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":4394.0,"discounted_cash":1537.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH VISC 5FR 65CM .038 RDC G08578","code_information":[{"code":"Px0000140478L","type":"CDM"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINN 7FR 10CM RSS704","code_information":[{"code":"Px0000140978L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":14.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":136.35,"discounted_cash":47.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":358.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":358.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TUBE TRANSGASTRIC JEJUN 22FR 025022","code_information":[{"code":"Px0000143925L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1107.0,"discounted_cash":387.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 7FR 10CM RSS702","code_information":[{"code":"Px0000144474L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":15.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINN 8FR 10CM RSS802","code_information":[{"code":"Px0000144475L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":15.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH CHECK-FLO 16FR 038 35CM G27023","code_information":[{"code":"Px0000144955L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":169.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE .038 9FR 10CM RSS902","code_information":[{"code":"Px0000144976L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":15.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":43.0,"discounted_cash":15.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTRODUCER ACCUSTICK INTRO SET M001207100","code_information":[{"code":"Px0000145243L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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":1759.0,"discounted_cash":615.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH VISC 5FR .038 65CM C2 G11994","code_information":[{"code":"Px0000154886L","type":"CDM"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE ROSEN 035 260 1.5 BH","code_information":[{"code":"Px0000155181L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT BILIARY 8FR 35CM M001271560","code_information":[{"code":"Px0000155285L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT BILIARY 10FR 35CM M001271570","code_information":[{"code":"Px0000155286L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WIRE MAILMAN 182CM H74912136012","code_information":[{"code":"Px0000156151L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":112.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WIRE SV5 .018 503558","code_information":[{"code":"Px0000156164L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT WALLGRAFT 7F 10X68 75CM","code_information":[{"code":"Px0000156301L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3576.0,"discounted_cash":1251.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WIRE MAILMAN 300 .014 H74912120012","code_information":[{"code":"Px0000156356L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":112.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH INFU CRAG-MCN 5FR 135/20 4105701","code_information":[{"code":"Px0000157257L","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: JV CPCT 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":485.0,"discounted_cash":169.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH IVUS VISIONS 3.4F 86700","code_information":[{"code":"Px0000158224L","type":"CDM"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":3499.0,"discounted_cash":1224.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":354.2,"discounted_cash":123.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE ROADRUNNER ANGL TIP","code_information":[{"code":"Px0000159069L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH SIZING PIG 5F 65CM 20MARK 532598C","code_information":[{"code":"Px0000159158L","type":"CDM"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH GUIDE VISTA BT 6F XB 3.5 SH 67005500","code_information":[{"code":"Px0000159320L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":201.0,"discounted_cash":70.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE COPE 018 60CM SS ST G09395","code_information":[{"code":"Px0000160276L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN CONQ 12X40MMX75CM CQ75124","code_information":[{"code":"Px0000161062L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NDL TRANSSEPTAL BRK 18G 71CM 407200","code_information":[{"code":"Px0000203292L","type":"CDM"}],"standard_charges":[{"gross_charge":756.0,"discounted_cash":264.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NDL TRANSSEPTAL BRK-1 71 CM 407201","code_information":[{"code":"Px0000203293L","type":"CDM"}],"standard_charges":[{"gross_charge":756.0,"discounted_cash":264.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH ANGIO SO1 5FX80CM .038 H787107120055","code_information":[{"code":"Px0000204973L","type":"CDM"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":42.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH SAFE 7FR 13CM HLS1007M","code_information":[{"code":"Px0000205073L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":54.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE ROSEN 035 180CM 1.5M G01264","code_information":[{"code":"Px0000205188L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":17.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":505.0,"discounted_cash":176.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":415.0,"discounted_cash":145.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH SUPER ARROWFLX 8FR 45CM CL07845","code_information":[{"code":"Px0000205904L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":145.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LEAD SCREW-IN 507652","code_information":[{"code":"Px0000206264L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE SPARTACORE 5/190 1005202","code_information":[{"code":"Px0000206332L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH RENAL CURVE RDC 4037553A","code_information":[{"code":"Px0000206756L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH G-J TUBE 18FR 30CM","code_information":[{"code":"Px0000207320L","type":"CDM"}],"standard_charges":[{"gross_charge":1001.63,"discounted_cash":350.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH FLEXR 10FR .038 80CM RB G13033","code_information":[{"code":"Px0000207916L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC HEMOSTAT SURGCEL FIB 4X4IN 1963","code_information":[{"code":"Px0000209160L","type":"CDM"}],"standard_charges":[{"gross_charge":812.0,"discounted_cash":284.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH SRO 8.5F 406853","code_information":[{"code":"Px0000211266L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":239.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GELMARK ULTRACOR S CLIP 14G GMUTC005SS","code_information":[{"code":"Px0000217039L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1225.0,"discounted_cash":428.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FILTER VENA CAVA OPTSE 6F/55CM 466F220A","code_information":[{"code":"Px0000217370L","type":"CDM"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":5138.0,"discounted_cash":1798.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TRAY PERCARDIOCENTISIS PIGTAIL PC101","code_information":[{"code":"Px0000217584L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MICRO INTRODUCER 4.5FR/5FR 678950","code_information":[{"code":"Px0000217954L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.6,"discounted_cash":56.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH SHUTTL 8FR .038 90CM HC G12836","code_information":[{"code":"Px0000218830L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH SR1 CRV 8.5FR 60CM 406854","code_information":[{"code":"Px0000219238L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":239.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN CONQ 9X40MMX75CM CQ7594","code_information":[{"code":"Px0000219265L","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: JV CPCT 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: JV CPCT 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: JV CPCT 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":290.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE TFE 035 180CM AUS","code_information":[{"code":"Px0000220609L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":42.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC KIT PERCLOSE PROGLIDE 6FR 1267303","code_information":[{"code":"Px0000221040L","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: JV CPCT 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":2083.0,"discounted_cash":729.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT MINIVISION RX 2.25 X 12M 100782212","code_information":[{"code":"Px0000221813L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2083.0,"discounted_cash":729.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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":2143.0,"discounted_cash":750.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT URET PERCUFLEX 6X24","code_information":[{"code":"Px0000227356L","type":"CDM"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":130.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN CUTTING PERI 8X2X90 M001PCB8020900","code_information":[{"code":"Px0000228073L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2083.0,"discounted_cash":729.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2083.0,"discounted_cash":729.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN VIATRC 4.0X20MMX135CM 100818920","code_information":[{"code":"Px0000228790L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN VIATRC 5.0X20MMX135CM MULT 100819320","code_information":[{"code":"Px0000228791L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN VIATRC 6.0X20MMX135CM 100819720","code_information":[{"code":"Px0000228792L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN VIATRAC 4 X 30MM 100818930","code_information":[{"code":"Px0000228794L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":580.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN VIATRAC 6 X 30MM 100819730","code_information":[{"code":"Px0000228796L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN VIATRAC 4 X 40MM 100818940","code_information":[{"code":"Px0000228797L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4376.0,"discounted_cash":1531.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE WHOLEY .035 X 175CM","code_information":[{"code":"Px0000229927L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH CEREB 5FR .038 100CM VERT","code_information":[{"code":"Px0000230034L","type":"CDM"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH CEREB 5FR .038 100CM H1","code_information":[{"code":"Px0000230536L","type":"CDM"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH CEREB 5FR .038 100CM ST","code_information":[{"code":"Px0000230824L","type":"CDM"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH DIAG 5FR 20 BAND 100CM","code_information":[{"code":"Px0000230883L","type":"CDM"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH EP 7FR DUO-DECA SLC LW 401904","code_information":[{"code":"Px0000231029L","type":"CDM"},{"code":"C1731","type":"HCPCS"}],"standard_charges":[{"gross_charge":4376.0,"discounted_cash":1531.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1708.0,"discounted_cash":597.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 5FR 10CM P RSS503","code_information":[{"code":"Px0000231277L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 6FR 10CM P","code_information":[{"code":"Px0000231278L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH DIAG 5FR 20 BAND 10S 65CM","code_information":[{"code":"Px0000231585L","type":"CDM"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH EP ABLT 7FR BD LC/XLS LWT 402274","code_information":[{"code":"Px0000231698L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":2601.0,"discounted_cash":910.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ELECTRODE CATH 6FR QUAD JSN 401430","code_information":[{"code":"Px0000231814L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":185.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WIRE CORONARY 300CM BMW UNIV 1009661","code_information":[{"code":"Px0000233335L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE TFE 035 180CM AES G03330","code_information":[{"code":"Px0000233884L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":42.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":212.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WIRE CHOICE PT EX SUP 300CM H74912155012","code_information":[{"code":"Px0000235648L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":112.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE BENTSON 035 180CM BH","code_information":[{"code":"Px0000235829L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":88.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE SPARTA .014 300CM 1005203","code_information":[{"code":"Px0000235867L","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: JV CPCT 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":212.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN CONQ 6X20MMX75CM CQ7562","code_information":[{"code":"Px0000236846L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN CONQ 8MMX2X75CM CQ7582","code_information":[{"code":"Px0000236847L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN CONQUEST 10X2X75 P CQ75102","code_information":[{"code":"Px0000236848L","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: JV CPCT 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":212.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PEG SAFETY PULL 20FR ZYLOCAINE M00566461","code_information":[{"code":"Px0000238337L","type":"CDM"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN FOX PLUS PTA .035 6X40X75 1275804","code_information":[{"code":"Px0000238354L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1948.0,"discounted_cash":681.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1948.0,"discounted_cash":681.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN FOX PLUS PTA .035 8X40X75 1276004","code_information":[{"code":"Px0000238360L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1948.0,"discounted_cash":681.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN FOX PLUS PTA .035 10X40X75 1276204","code_information":[{"code":"Px0000238366L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1948.0,"discounted_cash":681.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO PROGREAT 2.8FR 130","code_information":[{"code":"Px0000238473L","type":"CDM"}],"standard_charges":[{"gross_charge":1211.0,"discounted_cash":423.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":556.0,"discounted_cash":194.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN CODA 10FR 120CM G31236","code_information":[{"code":"Px0000238926L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":2303.0,"discounted_cash":806.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH SUPER ARROWFLX 6FR 24CM CL07624","code_information":[{"code":"Px0000239750L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":68.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 4FR 10CM RSS402","code_information":[{"code":"Px0000240869L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":15.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":245.0,"discounted_cash":85.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":212.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DRSG PRESSURE ASSIST 24CM 82000","code_information":[{"code":"Px0000241351L","type":"CDM"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WIRE ROSEN 260CM","code_information":[{"code":"Px0000244008L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH SUPER ARROWFLX 7FR 24CM CL07724","code_information":[{"code":"Px0000246866L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":68.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":197.0,"discounted_cash":68.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WIRE PT GRAPHICS GUIDEWIRE 0.14/182 CM","code_information":[{"code":"Px0000246920L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.5,"discounted_cash":79.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":683.0,"discounted_cash":239.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WIRE BHW H.W. .014 190CM 1000462H","code_information":[{"code":"Px0000247230L","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: JV CPCT 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":349.0,"discounted_cash":122.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":349.0,"discounted_cash":122.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH GUIDE AVE L 6FR EBU35 LA6EBU35","code_information":[{"code":"Px0000248183L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":79.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH CEREB 5FR .038 125CM VERT","code_information":[{"code":"Px0000248268L","type":"CDM"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":145.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN CONQUEST 7X2 75CM CQ7572","code_information":[{"code":"Px0000248559L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INFLATION DEVICE SPHERE 20CC G31027","code_information":[{"code":"Px0000248884L","type":"CDM"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":92.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":560.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT OMNILINK 7X28 80CM 100818028","code_information":[{"code":"Px0000248973L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2569.0,"discounted_cash":899.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":329.0,"discounted_cash":115.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT GRAFT BALLOON CATH REL46","code_information":[{"code":"Px0000249250L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1936.0,"discounted_cash":677.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CLIP CORMARK 14GA MAM3014","code_information":[{"code":"Px0000249297L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2083.0,"discounted_cash":729.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":111.0,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE BENTSON .035 260CM G01063","code_information":[{"code":"Px0000251863L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":55.0,"discounted_cash":19.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":55.0,"discounted_cash":19.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 8FR 10CM/0.38 RSS801","code_information":[{"code":"Px0000252899L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.44,"discounted_cash":12.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":531.0,"discounted_cash":185.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH 5FR X 65 X .038 10733401 H787107334015","code_information":[{"code":"Px0000253225L","type":"CDM"}],"standard_charges":[{"gross_charge":71.28,"discounted_cash":24.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH SIZING CENT 5.0FR 100CM .035 PIG G11916","code_information":[{"code":"Px0000253287L","type":"CDM"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":193.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":212.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1609.0,"discounted_cash":563.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH HEMOSTAR ST 14.5FR 23CM","code_information":[{"code":"Px0000254003L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1188.0,"discounted_cash":415.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH HEMOSTAR ST 14.5FR 19CM 5833690","code_information":[{"code":"Px0000254004L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1188.0,"discounted_cash":415.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 7X22X120 85455","code_information":[{"code":"Px0000254042L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7350.0,"discounted_cash":2572.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 8X38X80 85406","code_information":[{"code":"Px0000254048L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7350.0,"discounted_cash":2572.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 8X59X80 85407","code_information":[{"code":"Px0000254049L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7350.0,"discounted_cash":2572.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC KIT ROTA 2.0MM H749236310050","code_information":[{"code":"Px0000254059L","type":"CDM"},{"code":"C1724","type":"HCPCS"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN FLEXTOME CUT MONO 2.5X10 H749CBM3250100","code_information":[{"code":"Px0000254219L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2586.0,"discounted_cash":905.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WIRE AMPL ULTRASTIFF 035 260","code_information":[{"code":"Px0000254461L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":106.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MARKER TRIMARK 13 TRIMARKTD13MR","code_information":[{"code":"Px0000255507L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":95.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":224.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN ATLAS 7FR 14X40MMX120CM AT120144","code_information":[{"code":"Px0000255897L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1609.0,"discounted_cash":563.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH INTRO 6FR PRELUDE PSI6F11038","code_information":[{"code":"Px0000256940L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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":212.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WIRE CHOICE PT J GRAPHIX 300CM H7491215501J2","code_information":[{"code":"Px0000257829L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":112.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC D-STAT FLOWABLE 4000","code_information":[{"code":"Px0000257859L","type":"CDM"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN CSV 6FR 80CM BVCS6180","code_information":[{"code":"Px0000258744L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FOAM PVA-700 EMBL PRTCLE 1CC G09666","code_information":[{"code":"Px0000258773L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":161.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH VISC 5FR .038 65CM RIM","code_information":[{"code":"Px0000258774L","type":"CDM"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH GLIDE 4FR 100CM H1 CG404","code_information":[{"code":"Px0000259246L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":85.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6888.0,"discounted_cash":2410.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7932.0,"discounted_cash":2776.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COIL FIBERED VORTEX 3MM-7MM M0013733071","code_information":[{"code":"Px0000259866L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE BMW J 300CM 1001782J","code_information":[{"code":"Px0000259907L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.5,"discounted_cash":79.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN FOX PLUS PTA .035 12X20X80","code_information":[{"code":"Px0000260591L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1948.0,"discounted_cash":681.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH GUIDE VISTA BT 6F XBLAD 3 67006600","code_information":[{"code":"Px0000261049L","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: JV CPCT 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: JV CPCT 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: JV CPCT 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":146.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ZIPWIRE .035IN 180CM STIF ANG M00146308B1","code_information":[{"code":"Px0000262015L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH 7FR 45CM RDC RSR15","code_information":[{"code":"Px0000262321L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 11F 10CM RSS103","code_information":[{"code":"Px0000263214L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.44,"discounted_cash":12.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 7X100MM X 120CM PRB3507100120","code_information":[{"code":"Px0000263509L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2886.0,"discounted_cash":1010.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PRONTO V3 EXTRACT 5003","code_information":[{"code":"Px0000263563L","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: JV CPCT 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":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2886.0,"discounted_cash":1010.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ANGIOSEAL VIP 6F 610130","code_information":[{"code":"Px0000292099L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":895.0,"discounted_cash":313.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH SIZING FLUSH OMNI 5F100CM","code_information":[{"code":"Px0000293030L","type":"CDM"}],"standard_charges":[{"gross_charge":1099.0,"discounted_cash":384.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN FOX PTA 9.0 X 20 X 135CM","code_information":[{"code":"Px0000293740L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1948.0,"discounted_cash":681.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":310.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN FOX PLUS PTA .035 4X20X80","code_information":[{"code":"Px0000293757L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1948.0,"discounted_cash":681.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1948.0,"discounted_cash":681.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN FOX PLUS PTA .035 4X40X80 1275604","code_information":[{"code":"Px0000293760L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1948.0,"discounted_cash":681.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1948.0,"discounted_cash":681.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LEAD CAPSURE SENSE 407452","code_information":[{"code":"Px0000294663L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH SOS OMNI 3 5FR 80CM H787107204065","code_information":[{"code":"Px0000294813L","type":"CDM"}],"standard_charges":[{"gross_charge":76.14,"discounted_cash":26.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ANGIOSEAL VIP 8F 610131","code_information":[{"code":"Px0000295175L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":895.0,"discounted_cash":313.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SET NEFF ACCS CHIBA 21GA RH NT","code_information":[{"code":"Px0000295190L","type":"CDM"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":176.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":212.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PORT IMP MRI POWERPORT 8FR 1808000","code_information":[{"code":"Px0000296791L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.0,"discounted_cash":502.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1678.0,"discounted_cash":587.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH LANGSTON DUAL PIG 6F 110C 5540","code_information":[{"code":"Px0000298588L","type":"CDM"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":225.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTRODUCER AGILIS NXT 408309","code_information":[{"code":"Px0000298598L","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":4145.0,"discounted_cash":1450.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH HEMOSTAR KIT 14FRX19CM","code_information":[{"code":"Px0000299150L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1530.0,"discounted_cash":535.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH CHECK-FLO 12FR 038 13CM G07601","code_information":[{"code":"Px0000300013L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":96.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PICC GRSH DL 5FR 55CM TY","code_information":[{"code":"Px0000300044L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.6,"discounted_cash":235.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH SIZING PIG 5F 100C 21MARK H787137098035","code_information":[{"code":"Px0000300292L","type":"CDM"}],"standard_charges":[{"gross_charge":985.0,"discounted_cash":344.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PICC PWR SL 4FR","code_information":[{"code":"Px0000300349L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":169.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":804.0,"discounted_cash":281.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MARKER BIOPSY TRIMARKTD2S13MR","code_information":[{"code":"Px0000302488L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":95.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4883.0,"discounted_cash":1709.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4883.0,"discounted_cash":1709.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4883.0,"discounted_cash":1709.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4883.0,"discounted_cash":1709.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 6X80MMX120CM PRB3506080120","code_information":[{"code":"Px0000303668L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 7X80MMX120CM PRB3507080120","code_information":[{"code":"Px0000303669L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH SILVERHAWK EXL P4044","code_information":[{"code":"Px0000303982L","type":"CDM"}],"standard_charges":[{"gross_charge":12040.0,"discounted_cash":4214.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH MEDIA KUMPE 5FR 100CM H787107327035","code_information":[{"code":"Px0000304047L","type":"CDM"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT VISI-PRO 8 X 17MM X 80CM PXB350817080","code_information":[{"code":"Px0000304431L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT VISI-PRO 8 X 27MM X 80CM PXB350827080","code_information":[{"code":"Px0000304432L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COIL DETACHABLE AZUR 4MMX10CM 45480410","code_information":[{"code":"Px0000305562L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3020.05,"discounted_cash":1057.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CONTROLLER DETACHMENT 454001","code_information":[{"code":"Px0000305564L","type":"CDM"}],"standard_charges":[{"gross_charge":669.48,"discounted_cash":234.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH EP CRD2 6FX5MM 402004 402004","code_information":[{"code":"Px0000305615L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":185.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WIRE STEEL CORE 18 .018 190CM 1003281","code_information":[{"code":"Px0000305619L","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: JV CPCT 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":561.0,"discounted_cash":196.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT HERCULES 5.0 X 15 X 80","code_information":[{"code":"Px0000306469L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2141.0,"discounted_cash":749.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7785.0,"discounted_cash":2724.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTRODUCER PUNCTURE MICRO STIF G48008","code_information":[{"code":"Px0000307502L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MARKER TISSUE ULTRACLIP2 COIL 864017","code_information":[{"code":"Px0000307940L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH CEREB 5FR 125CM .035 HI","code_information":[{"code":"Px0000308211L","type":"CDM"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH FLUSH 4FR 65CM .035 VCF","code_information":[{"code":"Px0000308233L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":19.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH FLUSH 5FR 65CM .035 VCF","code_information":[{"code":"Px0000308237L","type":"CDM"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":19.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH CEREB 4FR .038 100CM H1","code_information":[{"code":"Px0000308271L","type":"CDM"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH VISC 4FR .038 65CM KMP","code_information":[{"code":"Px0000308285L","type":"CDM"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH CEREB 5FR .038 100CM DAV G11996","code_information":[{"code":"Px0000308289L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH VISC 5FR .038 65CM KMP","code_information":[{"code":"Px0000308300L","type":"CDM"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PNEUMOTHORX 10FR 30CM PIG","code_information":[{"code":"Px0000308340L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.05,"discounted_cash":179.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":237.0,"discounted_cash":82.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH ANSEL1 7FR 018/038 55CM","code_information":[{"code":"Px0000308398L","type":"CDM"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":101.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH TRANSS SL3 8.5F","code_information":[{"code":"Px0000308606L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":239.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PICC SHERLOCK SOLO DL 5FR 9295108","code_information":[{"code":"Px0000308654L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":848.8,"discounted_cash":297.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LEAD ACUITY SPIRAL 4591","code_information":[{"code":"Px0000309038L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":4962.0,"discounted_cash":1736.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PICC SOLO SHRLCK TL 6FR 9396108","code_information":[{"code":"Px0000309848L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.04,"discounted_cash":257.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC KIT POWER PORT PICC 4FR SL 9194108","code_information":[{"code":"Px0000309849L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":295.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC KIT CATH PERITONEAL PLEURX 509000B","code_information":[{"code":"Px0000311242L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":2663.0,"discounted_cash":932.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ATLAS 14X2 75CM AT75142","code_information":[{"code":"Px0000311300L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1609.0,"discounted_cash":563.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LEAD ATR/VENT BIPLR 5.7FR 45CM 407645","code_information":[{"code":"Px0000311398L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LEAD ATR/VENT BIPLR 5.7FR 52CM 407652","code_information":[{"code":"Px0000311399L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LEAD ATR/VENT BIPLR 5.7FR 58CM 407658","code_information":[{"code":"Px0000311400L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN HEP 7X5X120 VBH070502","code_information":[{"code":"Px0000311518L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9747.5,"discounted_cash":3411.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN HEP 8X5X120 VBH080502","code_information":[{"code":"Px0000311521L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":11209.0,"discounted_cash":3923.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MICROSPHERE CONTOUR SE 700-900 M001761472","code_information":[{"code":"Px0000311628L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":922.0,"discounted_cash":322.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NDL BRST LOCALIZATN 20GX5CM","code_information":[{"code":"Px0000311867L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.45,"discounted_cash":51.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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":2837.0,"discounted_cash":992.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH ABLTN BI-DIRECT 7FR 402811","code_information":[{"code":"Px0000311882L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":2837.0,"discounted_cash":992.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH ABLATION SAFIRE TX LC 7FR 402840","code_information":[{"code":"Px0000311883L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":4168.0,"discounted_cash":1458.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTRO GUIDEWIRE J-TIP FIX CORE","code_information":[{"code":"Px0000311885L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE .035IN 180CM L 3MM J","code_information":[{"code":"Px0000311887L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PICC PRESS DL 5FR 50CM CDC05052HPK1A","code_information":[{"code":"Px0000312693L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":587.0,"discounted_cash":205.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PRONTO LP EXTRACT 5010","code_information":[{"code":"Px0000313645L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":1376.0,"discounted_cash":481.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PICC PRESS SL 3FR 55CM KT CDC05531PK1A","code_information":[{"code":"Px0000314099L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":185.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FILTER IVC FEMORAL DELIV KIT EC500F","code_information":[{"code":"Px0000314366L","type":"CDM"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":5203.0,"discounted_cash":1821.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FEM COMPRESSION WITH MANOMETER C11165","code_information":[{"code":"Px0000314807L","type":"CDM"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":148.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH VANSCHIE 5FR 65CM 5CVE G13793","code_information":[{"code":"Px0000317551L","type":"CDM"}],"standard_charges":[{"gross_charge":115.1,"discounted_cash":40.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH CRAGG INF 5F 038 135X5CM","code_information":[{"code":"Px0000320400L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ANGIOSEAL EVOLUTION 6FR C610134","code_information":[{"code":"Px0000324961L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":895.0,"discounted_cash":313.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":8463.0,"discounted_cash":2962.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE AMPLATZ ST .25 260CM","code_information":[{"code":"Px0000329724L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":31.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DEVICE PROTECTN SPIDER FX 6MM","code_information":[{"code":"Px0000330203L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":2888.0,"discounted_cash":1010.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COIL 10MMX20CM HELICAL 36-159 M001361590","code_information":[{"code":"Px0000334660L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1620.0,"discounted_cash":567.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE .032 180CM 404560","code_information":[{"code":"Px0000334693L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE .032 260CM 404878","code_information":[{"code":"Px0000334694L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PIGTAIL 4FR 65CM MARKER 77572MP65","code_information":[{"code":"Px0000334761L","type":"CDM"}],"standard_charges":[{"gross_charge":257.92,"discounted_cash":90.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTRODUCER SHEATH 20FR 261336 G12830","code_information":[{"code":"Px0000335057L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1759.0,"discounted_cash":615.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH 9FR .038 11CM 504609X","code_information":[{"code":"Px0000335132L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WALLSTNT ESOPH PARTCVR18X23X10 M00516900","code_information":[{"code":"Px0000336805L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH DIALYSIS 8FR 12CM HEMOSIL SL12P","code_information":[{"code":"Px0000337802L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"discounted_cash":222.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH 9FR 24CM SUPERFLEX","code_information":[{"code":"Px0000338064L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":68.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PORT POWER ISP IMPL MRI W/8FR","code_information":[{"code":"Px0000338147L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.0,"discounted_cash":502.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 7X40MMX80CM PRB3507040080","code_information":[{"code":"Px0000342686L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC POWER TRIALYSIS TEMP 30CM STRA","code_information":[{"code":"Px0000343407L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":651.65,"discounted_cash":228.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":857.0,"discounted_cash":299.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10035.0,"discounted_cash":3512.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PLUG VASCULAR AMPLATZER 10X9MM 9AVP2010","code_information":[{"code":"Px0000344886L","type":"CDM"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":3952.0,"discounted_cash":1383.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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":3031.0,"discounted_cash":1060.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 6X150MMX135CM AB35W06150135","code_information":[{"code":"Px0000347564L","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: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 5X100MMX135CM AB35W05100135","code_information":[{"code":"Px0000348129L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT URO UNVRS FRM 6FR 22CM G49904","code_information":[{"code":"Px0000348242L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6449.0,"discounted_cash":2257.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EMBOSHIELD NAV6 7.2MM 2243819","code_information":[{"code":"Px0000349376L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":6845.0,"discounted_cash":2395.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MARKER BIOPSY SITE 1ST SMARKEVIVA13","code_information":[{"code":"Px0000349450L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.04,"discounted_cash":70.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":340.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PLUG VASCULAR AMPLATZ 16X12MM 9AVP2016","code_information":[{"code":"Px0000349829L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3952.0,"discounted_cash":1383.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI LIFSTNT 6X60MMX130C EX060603CS","code_information":[{"code":"Px0000349862L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4512.5,"discounted_cash":1579.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT WALLFLEX BIL RX UNC 8X60 M00570610","code_information":[{"code":"Px0000350353L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5600.0,"discounted_cash":1960.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN HEP 10X5X120","code_information":[{"code":"Px0000350740L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":11209.0,"discounted_cash":3923.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2663.0,"discounted_cash":932.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":340.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PERIPH TURBOHAWK THSLXC","code_information":[{"code":"Px0000351173L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":12947.0,"discounted_cash":4531.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PERIPH TURBOHAWK THLXM","code_information":[{"code":"Px0000351175L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":12947.0,"discounted_cash":4531.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WIRE LUNDERQUIST DBL CRV 300CM TSCMG-35-300-LESDC G45408","code_information":[{"code":"Px0000351177L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO-GUIDE FINECROSS 351430","code_information":[{"code":"Px0000351348L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2083.0,"discounted_cash":729.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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":498.95,"discounted_cash":174.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN CODA 10FR 40MMX120CM G53025","code_information":[{"code":"Px0000355014L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":1414.0,"discounted_cash":494.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PIONEER PLUS 6FR 120CM PPLUS120","code_information":[{"code":"Px0000355078L","type":"CDM"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":11395.0,"discounted_cash":3988.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SNARE VASC EN 7FR CATH 18-30MM EN2007030","code_information":[{"code":"Px0000355558L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1606.0,"discounted_cash":562.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ELECTRODE CATH 6FR QUAD -REP 401430RH","code_information":[{"code":"Px0000356117L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH EP CRD2 6FX5MM -REP 402004RH","code_information":[{"code":"Px0000356138L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH DESTINATION 7FR 45CM 5474501","code_information":[{"code":"Px0000356889L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LEAD TENDRIL PACING STS 6F 2088TC46","code_information":[{"code":"Px0000356894L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH GLIDESHEATH 6FR 10CM 401060","code_information":[{"code":"Px0000357182L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH TRAILBLAZER .014 X 135CM SC014135","code_information":[{"code":"Px0000357186L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"discounted_cash":222.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH TRAILBLAZER .035 X 135CM SC035135","code_information":[{"code":"Px0000357191L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"discounted_cash":222.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":720.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH INTRO 8.5FR","code_information":[{"code":"Px0000357337L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.02,"discounted_cash":11.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":804.0,"discounted_cash":281.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1609.0,"discounted_cash":563.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FILTER CELECT JUGULAR 65CM","code_information":[{"code":"Px0000357680L","type":"CDM"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":3496.0,"discounted_cash":1223.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOCROSS 2.0X80MMX150CM","code_information":[{"code":"Px0000357681L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10788.0,"discounted_cash":3775.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH 8FR 90CM FJ CRV","code_information":[{"code":"Px0000358245L","type":"CDM"}],"standard_charges":[{"gross_charge":2692.0,"discounted_cash":942.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1906.0,"discounted_cash":667.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1906.0,"discounted_cash":667.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH LASSO 2515 VARIABLE -REP","code_information":[{"code":"Px0000359144L","type":"CDM"},{"code":"C1731","type":"HCPCS"}],"standard_charges":[{"gross_charge":2716.0,"discounted_cash":950.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":485.0,"discounted_cash":169.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PATCH EXTERNAL REF CARTO3 CREFP6","code_information":[{"code":"Px0000360347L","type":"CDM"}],"standard_charges":[{"gross_charge":1718.0,"discounted_cash":601.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":177.0,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SET FILTER FEMORAL CELECT G52914","code_information":[{"code":"Px0000361117L","type":"CDM"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":5203.0,"discounted_cash":1821.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3957.0,"discounted_cash":1384.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE VIPER ADV.014-.017 VPRGW17","code_information":[{"code":"Px0000362558L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTRODUCER PEG KIT 20FR","code_information":[{"code":"Px0000362844L","type":"CDM"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":231.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH GLIDESHEATH 5FR 10CM 301055","code_information":[{"code":"Px0000363058L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":138.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FILTER OPTION IVC 30MM 352506070","code_information":[{"code":"Px0000363609L","type":"CDM"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":4513.0,"discounted_cash":1579.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOCROSS 2.5X210MMX150CM AB14W025210150","code_information":[{"code":"Px0000364288L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 3.0X210MMX150CM AB14W030210150","code_information":[{"code":"Px0000364289L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOCROSS 3.5X210MMX150CM AB14W035210150","code_information":[{"code":"Px0000364290L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOCROSS 3.0X150MMX150CM AB14W030150150","code_information":[{"code":"Px0000364294L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOCROSS 4.0X150MMX150CM AB14W040150150","code_information":[{"code":"Px0000364296L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PLUG VASCULAR 22X9MM 9AVP2022","code_information":[{"code":"Px0000364514L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3952.0,"discounted_cash":1383.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3499.0,"discounted_cash":1224.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI EVRFLX 8X80MMX80CM PRB3508080080","code_information":[{"code":"Px0000365167L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DRAIN ASPIRA PERITONEAL","code_information":[{"code":"Px0000365188L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":2100.0,"discounted_cash":735.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 4X40MMX135CM AB35W04040135","code_information":[{"code":"Px0000365456L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 5X200MMX135CM AB35W05200135","code_information":[{"code":"Px0000365460L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 6X40MMX135CM AB35W06040135","code_information":[{"code":"Px0000365462L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 6X200MMX135CM AB35W06200135","code_information":[{"code":"Px0000365466L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 7X200MMX135CM AB35W07200135","code_information":[{"code":"Px0000365472L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 8X40MMX135CM AB35W08040135","code_information":[{"code":"Px0000365475L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 8X60MMX135CM AB35W08060135","code_information":[{"code":"Px0000365476L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 8X80MMX135CM AB35W08080135","code_information":[{"code":"Px0000365477L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 5X80MMX80CM AB35W05080080","code_information":[{"code":"Px0000365481L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 6X40MMX80CM AB35W06040080","code_information":[{"code":"Px0000365486L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 7X40MMX80CM AB35W07040080","code_information":[{"code":"Px0000365489L","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: JV CPCT 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":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 8X40MMX80CM AB35W08040080","code_information":[{"code":"Px0000365497L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 9.0X2X80 AB35W09020080","code_information":[{"code":"Px0000365502L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 9.0X4X80 AB35W09040080","code_information":[{"code":"Px0000365504L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 10X40MMX80CM AB35W10040080","code_information":[{"code":"Px0000365508L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC KIT INTRODUCER MICKEY G-20 98434","code_information":[{"code":"Px0000365855L","type":"CDM"}],"standard_charges":[{"gross_charge":994.95,"discounted_cash":348.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH 5FR 65CM KUMPE","code_information":[{"code":"Px0000366129L","type":"CDM"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC HEART TRAIL 3 6FR IR 1.0 406380","code_information":[{"code":"Px0000366153L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT VISI-PRO 9 X 27MM X 80CM PXB350927080","code_information":[{"code":"Px0000366296L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT VISI-PRO 10X27MMX80CM PXB351027080","code_information":[{"code":"Px0000366298L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT VISI-PRO 10X57MMX80CM PXB351057080","code_information":[{"code":"Px0000366300L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":366.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MARKER HYDROMARK BRST 12GA 3","code_information":[{"code":"Px0000366501L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":92.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH ANSEL 5FR 90CM G48189","code_information":[{"code":"Px0000366551L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC POWDER ABSRB ARISTA 3GM SM0002USA","code_information":[{"code":"Px0000366562L","type":"CDM"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LAUREATE WIRE-HYDROPHILLIC LWSTDA35180","code_information":[{"code":"Px0000367901L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":52.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WIRE LAUREATE HYDROPHILLIC LWSTDA35260EX","code_information":[{"code":"Px0000368147L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":52.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PRELUDE PRO 4F 11CM","code_information":[{"code":"Px0000368148L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PRELUDE PRO 5F 11CM","code_information":[{"code":"Px0000368149L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.76,"discounted_cash":13.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":38.76,"discounted_cash":13.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTRODUCER SHEATH 7F 11X35","code_information":[{"code":"Px0000368322L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.76,"discounted_cash":13.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH FLEXOR ANSEL 12FR 45CM G47701","code_information":[{"code":"Px0000368844L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.75,"discounted_cash":93.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMADA .014 2.5X60X150 A2025060","code_information":[{"code":"Px0000369839L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMADA .014 2.5X80X150 A2025080","code_information":[{"code":"Px0000369840L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC KIT ELECTRODE NAVX VELOCITY","code_information":[{"code":"Px0000370326L","type":"CDM"}],"standard_charges":[{"gross_charge":4859.0,"discounted_cash":1700.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 2.0X210MMX150CM AB14W020210150","code_information":[{"code":"Px0000370695L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT WALLFLEX 10X80 PC M00570740","code_information":[{"code":"Px0000372402L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7000.0,"discounted_cash":2450.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PERIPH TURBOHAWK THSSXC","code_information":[{"code":"Px0000372995L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":12947.0,"discounted_cash":4531.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PERIPH TURBOHAWK THSSSC","code_information":[{"code":"Px0000372996L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":12947.0,"discounted_cash":4531.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 1.5X6MM 101244406","code_information":[{"code":"Px0000373267L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 1.5X8MM 101244408","code_information":[{"code":"Px0000373268L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 3.0X6MM 101244906","code_information":[{"code":"Px0000373276L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COVER VOLCANO DIGITAL IVUS","code_information":[{"code":"Px0000374353L","type":"CDM"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +6 30ML 9390130","code_information":[{"code":"Px0000375925L","type":"CDM"}],"standard_charges":[{"gross_charge":31.05,"discounted_cash":10.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +8 40ML 9390140","code_information":[{"code":"Px0000375926L","type":"CDM"}],"standard_charges":[{"gross_charge":29.2,"discounted_cash":10.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH INTRO 7F 4CM MARKER TIP PSS7F4MT","code_information":[{"code":"Px0000377958L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG J 180CM GR3525","code_information":[{"code":"Px0000378782L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG J 260CM GR3526","code_information":[{"code":"Px0000378783L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 3.5X40MMX150CM AB14W035040150","code_information":[{"code":"Px0000379063L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DEVICE CLEANER THRMBCTMY 65CM 700009XT","code_information":[{"code":"Px0000379276L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":2571.0,"discounted_cash":899.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4175.0,"discounted_cash":1461.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC KIT MICRO INTRO 4F 7266V","code_information":[{"code":"Px0000383847L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI VS-PRO 8X57MMX135CM PXB350857135","code_information":[{"code":"Px0000384081L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1813.5,"discounted_cash":634.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LEAD SPRINT QUATTRO 62CM 6947M62","code_information":[{"code":"Px0000384597L","type":"CDM"},{"code":"C1895","type":"HCPCS"}],"standard_charges":[{"gross_charge":9816.0,"discounted_cash":3435.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1040.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1040.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH RADIAL TIG 6F 4X100CM 406011","code_information":[{"code":"Px0000385584L","type":"CDM"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PICC PWR TL 5FR HF TY 3385108Q","code_information":[{"code":"Px0000386113L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":674.04,"discounted_cash":235.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI PRTG 10X40MMX120CM SERB651040120","code_information":[{"code":"Px0000386391L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT CAROTID 30X8MMX135CM SECX830135","code_information":[{"code":"Px0000386413L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3850.0,"discounted_cash":1347.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT CAROTID 20X10MMX135CM","code_information":[{"code":"Px0000386420L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3850.0,"discounted_cash":1347.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT CAROTID 30X8/6MMX135CM SECX8630135","code_information":[{"code":"Px0000386424L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3850.0,"discounted_cash":1347.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT CAROTID 40X8/6MMX135CM SECX8640135","code_information":[{"code":"Px0000386425L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4433.0,"discounted_cash":1551.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI VS-PRO 10X17MM80CM PXB351017080","code_information":[{"code":"Px0000386429L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI PARAMINI GPS 6X14MM PMB861480","code_information":[{"code":"Px0000386448L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI PARAMINI GPS 6X18MM PMB861880","code_information":[{"code":"Px0000386449L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 4X80MMX135CM AB35W04080135","code_information":[{"code":"Px0000386473L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 4X120MMX135CM AB35W04120135","code_information":[{"code":"Px0000386477L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 6X20MMX135CM AB35W06020135","code_information":[{"code":"Px0000386493L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 6X40MMX40CM AB35W06040040","code_information":[{"code":"Px0000386494L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 9X40MMX135CM AB35W09040135","code_information":[{"code":"Px0000386512L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 10X20MMX80CM AB35W10020080","code_information":[{"code":"Px0000386515L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 2.0X120MMX150CM AB14W020120150","code_information":[{"code":"Px0000386531L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 3.0X80MMX150CM AB14W030080150","code_information":[{"code":"Px0000386549L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 4.0X120MMX150CM AB14W040120150","code_information":[{"code":"Px0000386557L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 4.0X20MMX150CM AB14W040020150","code_information":[{"code":"Px0000386559L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LEAD ICD DURATA SJ4 7120Q 65CM 7120Q65","code_information":[{"code":"Px0000386726L","type":"CDM"},{"code":"C1895","type":"HCPCS"}],"standard_charges":[{"gross_charge":9816.0,"discounted_cash":3435.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9816.0,"discounted_cash":3435.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9816.0,"discounted_cash":3435.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4962.0,"discounted_cash":1736.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MARKER HYDROMARK 12G 1","code_information":[{"code":"Px0000387492L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":92.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH CVC POWER KIT 8.5 FR","code_information":[{"code":"Px0000388489L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":225.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH ENGAGE 4FR","code_information":[{"code":"Px0000388494L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ICDD FORTIFY ASSURA DR 40","code_information":[{"code":"Px0000389019L","type":"CDM"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":57120.0,"discounted_cash":19992.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CRT-D UNIFY ASSURA 40 CD3257","code_information":[{"code":"Px0000389029L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":73080.0,"discounted_cash":25578.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7155.0,"discounted_cash":2504.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SET TUBING COOL POINT 85785","code_information":[{"code":"Px0000390545L","type":"CDM"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH OPTISEAL VALV 7F 1000093002","code_information":[{"code":"Px0000390818L","type":"CDM"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":96.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PICC PWR 3CG TL 5FR HF MX 1395108QD","code_information":[{"code":"Px0000391897L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1328.0,"discounted_cash":464.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1232.55,"discounted_cash":431.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1100.0,"discounted_cash":385.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1158.0,"discounted_cash":405.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC HEMOSTAT FLOSEAL NDLSS 10ML KT","code_information":[{"code":"Px0000396021L","type":"CDM"}],"standard_charges":[{"gross_charge":1138.0,"discounted_cash":398.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BIO DECANAV F CURVE R7F282CT","code_information":[{"code":"Px0000398019L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN CHOC PTA .018 6X120X120 CB1812060120OTW","code_information":[{"code":"Px0000398110L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3528.0,"discounted_cash":1234.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4413.0,"discounted_cash":1544.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BARD PICC PWR 3FR SL","code_information":[{"code":"Px0000398836L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":790.0,"discounted_cash":276.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH GDE VBT 3DRC SH 6FR 100CM 67013100","code_information":[{"code":"Px0000401159L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":638.0,"discounted_cash":223.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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":625.0,"discounted_cash":218.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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: JV CPCT 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: JV CPCT 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: JV CPCT 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: JV CPCT 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":4513.0,"discounted_cash":1579.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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":4962.0,"discounted_cash":1736.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH CV POLY MDL SL 4FR 4154108D","code_information":[{"code":"Px0000425665L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.35,"discounted_cash":188.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FILTER VASC JUG DENALI DL900J DL900J","code_information":[{"code":"Px0000427230L","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: JV CPCT 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":1131.08,"discounted_cash":395.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":310.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":35875.0,"discounted_cash":12556.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":39940.0,"discounted_cash":13979.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN RAPIDX 3X40MMX170CM A14BX030040170","code_information":[{"code":"Px0000431901L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC KIT RETRIEV SNARE SHEATH 20MM SRK30","code_information":[{"code":"Px0000439078L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1238.0,"discounted_cash":433.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN CODA 9FR 32MMX120CM G03831","code_information":[{"code":"Px0000441101L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":2171.0,"discounted_cash":759.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH GDE ATTAIN CMD 6250VEH","code_information":[{"code":"Px0000441114L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1139.0,"discounted_cash":398.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":13675.0,"discounted_cash":4786.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SYS BONE MIXER DEL AUTOPLEX 0607687000","code_information":[{"code":"Px0000443079L","type":"CDM"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2660.0,"discounted_cash":931.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH REPERFUS INDIGO 5 5F 136CM CAT5","code_information":[{"code":"Px0000448634L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH ANGIO NAVICROSS ANG 90CM NC35901","code_information":[{"code":"Px0000449121L","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: JV CPCT 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":12947.0,"discounted_cash":4531.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LOOP RECORDER REVEA LNQ11","code_information":[{"code":"Px0000454083L","type":"CDM"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":18990.0,"discounted_cash":6646.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SYSTEM DETACHMENT INZONE M00345100950","code_information":[{"code":"Px0000454415L","type":"CDM"}],"standard_charges":[{"gross_charge":552.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7628.0,"discounted_cash":2669.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3664.6,"discounted_cash":1282.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7628.0,"discounted_cash":2669.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PRONTO V4 5.5FR 4005","code_information":[{"code":"Px0000456722L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":962.0,"discounted_cash":336.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT TISS EPIFIX 2X3CM GS5230","code_information":[{"code":"Px0000457175L","type":"CDM"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":953.0,"discounted_cash":333.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":13375.0,"discounted_cash":4681.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9650.0,"discounted_cash":3377.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":13375.0,"discounted_cash":4681.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A 6FR 6X25X120CM VBJR062502A","code_information":[{"code":"Px0000458396L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":25792.0,"discounted_cash":9027.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH ANGIO NAVICROSS ANG 150CM NC35151","code_information":[{"code":"Px0000459187L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2595.0,"discounted_cash":908.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SET ACCESS INTRAHEP TRAN 10FR G29769","code_information":[{"code":"Px0000460579L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2156.0,"discounted_cash":754.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN DC LUTONIX.035X5X80X130 LX35130580","code_information":[{"code":"Px0000461283L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN DC LUTNIX.035X5X100X130 LX351305100","code_information":[{"code":"Px0000461286L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN NCEUPHORA 3.0 X 12MM NCEUP3012X","code_information":[{"code":"Px0000462177L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SHEATH ANSEL1 6FR .035 70CM RB G56226","code_information":[{"code":"Px0000462788L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG ADV .014X180CM EA 1 EA","code_information":[{"code":"Px0000462939L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG ADV .014X300CM GA1430","code_information":[{"code":"Px0000462940L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1114.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC KT GD TRANSSPT 45D .032INX63CM","code_information":[{"code":"Px0000463119L","type":"CDM"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WIRE PGTL PROTRK .025INX230CM PTW25230","code_information":[{"code":"Px0000463120L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":323.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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":15066.0,"discounted_cash":5273.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PICC PWR SL 3FR","code_information":[{"code":"Px0000463826L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":178.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 4X40MMX130CM ADM04004013P","code_information":[{"code":"Px0000465009L","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: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 4X80MMX130CM ADM04008013P","code_information":[{"code":"Px0000465013L","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: JV CPCT 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: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 5X60MMX130CM ADM05006013P","code_information":[{"code":"Px0000465019L","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: JV CPCT 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: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 6X40MMX130CM ADM06004013P","code_information":[{"code":"Px0000465025L","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: JV CPCT 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: JV CPCT 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: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT TISS EPIFIX 18MM DISK GS5180","code_information":[{"code":"Px0000546501L","type":"CDM"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GRAFT AMNIOTIC EPIFIX 3.5X3.5CM ES3300","code_information":[{"code":"Px0000546506L","type":"CDM"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":174.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MESH EPFIX 4X 4.5 CM ES4400","code_information":[{"code":"Px0000546507L","type":"CDM"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":125.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH SOUNDSTAR ECO 8FR 10439011","code_information":[{"code":"Px0000547064L","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: JV CPCT 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":12427.0,"discounted_cash":4349.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN OTW ARMADA 6X20X90","code_information":[{"code":"Px0000590720L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":169.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TUBE JEJU G-JET 14FX1.2CMX22CM","code_information":[{"code":"Px0000591230L","type":"CDM"}],"standard_charges":[{"gross_charge":2144.0,"discounted_cash":750.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PNEUMOTHOR WAYNE 14FR G56533","code_information":[{"code":"Px0000591247L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":868.45,"discounted_cash":303.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GLIDESHEATH SLENDER 5FR 601050","code_information":[{"code":"Px0000591377L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":164.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GLIDESHEATH SLNDR SS 7FR 10CM 801070","code_information":[{"code":"Px0000591380L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":96.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PINNACLE PRECISION ACCESS 6FR","code_information":[{"code":"Px0000591661L","type":"CDM"}],"standard_charges":[{"gross_charge":1609.0,"discounted_cash":563.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FILTER IVC FEM CELECT PLAT G34502","code_information":[{"code":"Px0000593122L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH AZUR 3X10 45480310","code_information":[{"code":"Px0000593876L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3815.0,"discounted_cash":1335.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH AZUR 6X15","code_information":[{"code":"Px0000593880L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3190.69,"discounted_cash":1116.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 5X16 45780516","code_information":[{"code":"Px0000593898L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2850.0,"discounted_cash":997.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SET DIL ENVASC TPR 20-22FX45CM G52835","code_information":[{"code":"Px0000593952L","type":"CDM"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":295.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3120.0,"discounted_cash":1092.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3120.0,"discounted_cash":1092.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4703.0,"discounted_cash":1646.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN SCORING OTW PTA 7X40X90 23337040","code_information":[{"code":"Px0000595772L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":5510.0,"discounted_cash":1928.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN SCORING OTW PTA 8X40X90 23338040","code_information":[{"code":"Px0000595774L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":5510.0,"discounted_cash":1928.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2837.0,"discounted_cash":992.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2837.0,"discounted_cash":992.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2837.0,"discounted_cash":992.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2837.0,"discounted_cash":992.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5078.0,"discounted_cash":1777.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR13X24 45751324","code_information":[{"code":"Px0000610469L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5078.0,"discounted_cash":1777.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5078.0,"discounted_cash":1777.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 6X17 45750617","code_information":[{"code":"Px0000610471L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5078.0,"discounted_cash":1777.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 8X24 45750824","code_information":[{"code":"Px0000610473L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5078.0,"discounted_cash":1777.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DRSG ALGRFT GRAFIX PRIME 3X4 CM EA PS11034 12SQCM","code_information":[{"code":"Px0000610777L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.81,"discounted_cash":164.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DRSG ALGRFT GRAFIX CRE 1.5X2CM PS12015 3SQCM","code_information":[{"code":"Px0000610781L","type":"CDM"},{"code":"Q4132","type":"HCPCS"}],"standard_charges":[{"gross_charge":1307.0,"discounted_cash":457.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DRSG ALGRFT GRAFIX CRE 2X3CM PS12023","code_information":[{"code":"Px0000610782L","type":"CDM"},{"code":"Q4132","type":"HCPCS"}],"standard_charges":[{"gross_charge":787.71,"discounted_cash":275.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DRSG ALGRFT GRAFIX CRE 3X4CM PS12034","code_information":[{"code":"Px0000610783L","type":"CDM"},{"code":"Q4132","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH DIAG BRNSTN 4FR 125CM","code_information":[{"code":"Px0000610992L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":68.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH DIAG KA2 4FR 40X25CM","code_information":[{"code":"Px0000610993L","type":"CDM"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":68.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH DIAG BRNSTN 4FR 65X25CM","code_information":[{"code":"Px0000610994L","type":"CDM"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":68.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH DIAG KA2 5FR 65X25CM","code_information":[{"code":"Px0000610999L","type":"CDM"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":14.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN PROLACT RTF 26 100ML 95026100","code_information":[{"code":"Px0000616189L","type":"CDM"}],"standard_charges":[{"gross_charge":9.35,"discounted_cash":3.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MARKER TISS BRST ULTCOR 17G UCTW17","code_information":[{"code":"Px0000622671L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.95,"discounted_cash":140.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130CM 4X100 LX3513041005F","code_information":[{"code":"Px0000622711L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130CM 4X120 EA LX3513041205F","code_information":[{"code":"Px0000622712L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130CM 4X40 LX351304405F","code_information":[{"code":"Px0000622714L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130CM 5X100 LX3513051005F","code_information":[{"code":"Px0000622717L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130CM 5X120 LX3513051205F","code_information":[{"code":"Px0000622718L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130CM 5X40 LX351305405F","code_information":[{"code":"Px0000622720L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130 CM 5X60 EA 1 EA LX351305605F","code_information":[{"code":"Px0000622721L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PROGREAT 2.4FR 110CM MC*PB2411Y","code_information":[{"code":"Px0000637735L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GRAFT HUM TISS EPICORD 2X3 CM EC5230 6SQCM","code_information":[{"code":"Px0000640227L","type":"CDM"},{"code":"Q4187","type":"HCPCS"}],"standard_charges":[{"gross_charge":1084.83,"discounted_cash":379.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MATRIX PURAPLY AM 2X4CM PURAPLYAMCOM2X4 8SQCM","code_information":[{"code":"Px0000642892L","type":"CDM"},{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.38,"discounted_cash":187.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PERIPH HAWKONE H1M","code_information":[{"code":"Px0000643290L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":13461.0,"discounted_cash":4711.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PERIPH HAWKONE H1S","code_information":[{"code":"Px0000643291L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":13461.0,"discounted_cash":4711.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PATCH ENSITE PRECIS NAVX SE EN0020P","code_information":[{"code":"Px0000643313L","type":"CDM"}],"standard_charges":[{"gross_charge":4859.0,"discounted_cash":1700.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN CODA 9FR 32MMX100CM G03832","code_information":[{"code":"Px0000643644L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":2170.7,"discounted_cash":759.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SET DIL ENVASC TPR 14F 45CM G52833","code_information":[{"code":"Px0000643652L","type":"CDM"}],"standard_charges":[{"gross_charge":695.0,"discounted_cash":243.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SET DIL ENVASC TPR 16-18FX45CM G52834","code_information":[{"code":"Px0000643653L","type":"CDM"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":323.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN VBX 7X59X135CM BXA075902A","code_information":[{"code":"Px0000646920L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9950.0,"discounted_cash":3482.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH THRMCL SF UNIDIR CRV D D134701","code_information":[{"code":"Px0000647102L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":13268.0,"discounted_cash":4643.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH THRMCL SF UNIDIR CRV F D134702","code_information":[{"code":"Px0000647103L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":13268.0,"discounted_cash":4643.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":14338.0,"discounted_cash":5018.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":14338.0,"discounted_cash":5018.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1916.0,"discounted_cash":670.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 3X8 45780308","code_information":[{"code":"Px0000648530L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH ABL FLEX SNSR BI-D D-F AFASEDF","code_information":[{"code":"Px0000659954L","type":"CDM"},{"code":"C2630","type":"HCPCS"}],"standard_charges":[{"gross_charge":7810.0,"discounted_cash":2733.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH ABL FLEX SNSR BI-D F-J AFASEFJ","code_information":[{"code":"Px0000659956L","type":"CDM"},{"code":"C2630","type":"HCPCS"}],"standard_charges":[{"gross_charge":7810.0,"discounted_cash":2733.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LOOP RECORDER CONFIRM RX DM3500","code_information":[{"code":"Px0000664060L","type":"CDM"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":14531.0,"discounted_cash":5085.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1960.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1960.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1960.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH IVUS VISIONS PV .014P RX 014R","code_information":[{"code":"Px0000664657L","type":"CDM"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":3499.0,"discounted_cash":1224.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH IVL SHOCKWAVE 4.0X60MM M732LPBC4060DX1","code_information":[{"code":"Px0000675591L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":11825.0,"discounted_cash":4138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH IVL SHOCKWAVE 6.0X60MM M732LPBC6060DX1","code_information":[{"code":"Px0000675595L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":11825.0,"discounted_cash":4138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH IVL SHOCKWAVE 6.5X60MM M732LPBC6560DX1","code_information":[{"code":"Px0000675596L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":11825.0,"discounted_cash":4138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH IVL SHOCKWAVE 7.0X60MM M732LPBC7060DX1","code_information":[{"code":"Px0000675597L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":11825.0,"discounted_cash":4138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH INDGO 8 W/TBNG XTORQ TIP EA CAT8XTORQ115KIT","code_information":[{"code":"Px0000679382L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":13888.6,"discounted_cash":4861.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH IVL SHOCKWAVE S4 2.5X4.0 S4IVL2540","code_information":[{"code":"Px0000679525L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":9075.0,"discounted_cash":3176.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH IVL SHOCKWAVE S4 3.5X4.0 S4IVL3540","code_information":[{"code":"Px0000679527L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":11825.0,"discounted_cash":4138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT GRAFIX PRIME PLS 16MM 2SQCM PS13016","code_information":[{"code":"Px0000682559L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":1103.0,"discounted_cash":386.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT GRAFIX PRIME PLS 1.5X2CM 3SQCM","code_information":[{"code":"Px0000682560L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":1307.0,"discounted_cash":457.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT GRAFIX PRIME PLS 2X3CM PS13023 6SQCM","code_information":[{"code":"Px0000682561L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":787.71,"discounted_cash":275.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT GRAFIX PRIME PLS 3X3CM PS13033 9SQCM","code_information":[{"code":"Px0000682562L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":218.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN AVAFLEX CRV 11G 15MM 1031115000","code_information":[{"code":"Px0000716984L","type":"CDM"}],"standard_charges":[{"gross_charge":9680.0,"discounted_cash":3388.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CANSTR ENGINE FOR INDIGO SYSTE IAPS3","code_information":[{"code":"Px0000720439L","type":"CDM"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN IN.PACT AV DCB 6X40X80 6F IAV06004008P","code_information":[{"code":"Px0000760092L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":5580.0,"discounted_cash":1953.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLN IN.PACT AV DCB 12X40X130 9 IAV12004013P","code_information":[{"code":"Px0000760128L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":7200.0,"discounted_cash":2520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT DERM PLIABLE THIN 10X17 170SQCM SF1500","code_information":[{"code":"Px0000772285L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.25,"discounted_cash":26.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT VASC ELUVIA 6X100X130CM H74939294601010","code_information":[{"code":"Px0000782607L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9787.5,"discounted_cash":3425.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT DEEP VEIN ABRE 14MM 100M AB9U14100090","code_information":[{"code":"Px0000833536L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STENT DEEP VEIN ABRE 14MM 150M AB9U14150090","code_information":[{"code":"Px0000833538L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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: JV CPCT 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: JV CPCT 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: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SEPARATOR 7D INDGO 90CM SEP7D","code_information":[{"code":"Px0000841117L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":7200.0,"discounted_cash":2520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH INDGO 7D W/ TBNG CAT7DKIT","code_information":[{"code":"Px0000841118L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":11223.0,"discounted_cash":3928.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT DISK EPIFIX 18MM 3SQCM GS-5180-10","code_information":[{"code":"Px0000847486L","type":"CDM"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":987.62,"discounted_cash":345.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT EPIFIX 2X2CM 4SQCM GS-5220-10","code_information":[{"code":"Px0000847487L","type":"CDM"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":1035.62,"discounted_cash":362.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH INDIGO HTORQ 12MM 100CM LITNG12HTORQ100","code_information":[{"code":"Px0000868387L","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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC KERECIS OMEGA3 3X3.5CM FATTY ACIDS GRAFT WOUND DRSG 50200S01B2D 11SQCM","code_information":[{"code":"Px0001005408L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.48,"discounted_cash":106.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC KERECIS OMEGA3 5X7CM FATTY ACIDS GRAFT WOUND DRSG 50200S05B2D 35SQCM","code_information":[{"code":"Px0001005430L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.35,"discounted_cash":63.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC KERECIS OMEGA3 3X7CM FATTY ACIDS GRAFT WOUND DRSG 50200S0 21SQCM","code_information":[{"code":"Px0001005431L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.61,"discounted_cash":91.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC KERECIS OMEGA3 16MM FATTY ACIDS GRAFT WOUND DRSG 50200S16B2D 2SQCM","code_information":[{"code":"Px0001005432L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":1072.61,"discounted_cash":375.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC KERECIS OMEGA3 1.75X1.75CM FATTY ACIDS GRAFT WOUND DRESSING 50200S00B2D","code_information":[{"code":"Px0001005438L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.34,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PACK SURG THROMBECTOMY CATH7 ASPIRATION TUBING 130CM TORQ+ LITNGBT7TQ130","code_information":[{"code":"Px0001016823L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":33189.2,"discounted_cash":11616.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH CV POWERGLIDE PRO 18GAX10CM  F418108PT","code_information":[{"code":"Px0001111746L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.85,"discounted_cash":200.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE","code_information":[{"code":"Px00012010001","type":"CDM"}],"standard_charges":[{"gross_charge":5610.0,"discounted_cash":1963.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE MED/SURG GYN","code_information":[{"code":"Px00012110001","type":"CDM"}],"standard_charges":[{"gross_charge":5620.0,"discounted_cash":1967.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC R&B- SEMI-PRIVATE ED BOARDER","code_information":[{"code":"Px00012110005","type":"CDM"}],"standard_charges":[{"gross_charge":6181.0,"discounted_cash":2163.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE OB","code_information":[{"code":"Px00012210001","type":"CDM"}],"standard_charges":[{"gross_charge":5620.0,"discounted_cash":1967.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE OB HIGH RISK","code_information":[{"code":"Px00012210003","type":"CDM"}],"standard_charges":[{"gross_charge":7927.0,"discounted_cash":2774.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE PEDIATRIC","code_information":[{"code":"Px00012310001","type":"CDM"}],"standard_charges":[{"gross_charge":6181.0,"discounted_cash":2163.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE ONCOLOGY","code_information":[{"code":"Px00012710001","type":"CDM"}],"standard_charges":[{"gross_charge":9070.0,"discounted_cash":3174.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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":3970.0,"discounted_cash":1389.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC R&B NURSERY/LEVEL 1","code_information":[{"code":"Px00017110001","type":"CDM"}],"standard_charges":[{"gross_charge":3131.0,"discounted_cash":1095.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC R&B NURSERY/LEVEL 2","code_information":[{"code":"Px00017210001","type":"CDM"}],"standard_charges":[{"gross_charge":9023.0,"discounted_cash":3158.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC R&B NURSERY/LEVEL 3","code_information":[{"code":"Px00017310001","type":"CDM"}],"standard_charges":[{"gross_charge":15485.0,"discounted_cash":5419.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC R&B NURSERY/LEVEL 4","code_information":[{"code":"Px00017410001","type":"CDM"}],"standard_charges":[{"gross_charge":21658.0,"discounted_cash":7580.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTENSIVE CARE 12","code_information":[{"code":"Px00020010003","type":"CDM"}],"standard_charges":[{"gross_charge":14515.0,"discounted_cash":5080.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTENSIVE CARE 11","code_information":[{"code":"Px00020010004","type":"CDM"}],"standard_charges":[{"gross_charge":20983.0,"discounted_cash":7344.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTENSIVE CARE LEVEL 1","code_information":[{"code":"Px00020010006","type":"CDM"}],"standard_charges":[{"gross_charge":13239.0,"discounted_cash":4633.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTENSIVE CARE LEVEL 2","code_information":[{"code":"Px00020010007","type":"CDM"}],"standard_charges":[{"gross_charge":19076.0,"discounted_cash":6676.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTENSIVE CARE PEDIATRIC 12","code_information":[{"code":"Px00020310002","type":"CDM"}],"standard_charges":[{"gross_charge":15391.0,"discounted_cash":5386.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTENSIVE CARE PEDIATRIC 11","code_information":[{"code":"Px00020310003","type":"CDM"}],"standard_charges":[{"gross_charge":21617.0,"discounted_cash":7565.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC R&B INTERMEDIATE LVL 1","code_information":[{"code":"Px00020600001","type":"CDM"}],"standard_charges":[{"gross_charge":9256.0,"discounted_cash":3239.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC R&B INTERMEDIATE LVL 2","code_information":[{"code":"Px00020600002","type":"CDM"}],"standard_charges":[{"gross_charge":8206.0,"discounted_cash":2872.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CORONARY CARE/LEVEL 1","code_information":[{"code":"Px00021010004","type":"CDM"}],"standard_charges":[{"gross_charge":13239.0,"discounted_cash":4633.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CORONARY CARE/LEVEL 2","code_information":[{"code":"Px00021010005","type":"CDM"}],"standard_charges":[{"gross_charge":19076.0,"discounted_cash":6676.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CORONARY CARE INTERMEDIATE","code_information":[{"code":"Px00021410001","type":"CDM"}],"standard_charges":[{"gross_charge":9027.0,"discounted_cash":3159.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":714.0,"discounted_cash":249.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLOOD DRAW PICC OR NONIMPLANTED CENTRAL LINE CDM","code_information":[{"code":"Px00026010006","type":"CDM"},{"code":"36592","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.0,"discounted_cash":265.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IV HYDRATION INITIAL HR CDM","code_information":[{"code":"Px00026010007","type":"CDM"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":1076.0,"discounted_cash":376.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":159.0,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IV INFUSION INITIAL HR CDM","code_information":[{"code":"Px00026010009","type":"CDM"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":1182.0,"discounted_cash":413.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":159.0,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":220.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IV INFUSION CONCURRENT DRUG CDM","code_information":[{"code":"Px00026010012","type":"CDM"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2605.0,"discounted_cash":911.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ORTHOTIC DEVICE","code_information":[{"code":"Px00027010121","type":"CDM"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NITRIC OXIDE THERAPY HOURLY CDM","code_information":[{"code":"Px00027010142","type":"CDM"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CLIP TISSUE MARKER","code_information":[{"code":"Px00027210500","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":92.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BRACHY NON-STRAND IODINE-125 PER SOURCE","code_information":[{"code":"Px00027810501","type":"CDM"},{"code":"C2639","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OPTIME SHELL 278 C1889","code_information":[{"code":"Px00027810690","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":10125.0,"discounted_cash":3543.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":502.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":502.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":260.0,"discounted_cash":91.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CELL COUNT MISCELLANEOUS BODY FLUIDS LAB","code_information":[{"code":"Px00030000007","type":"CDM"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":502.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":502.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":502.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BLOOD DRAW VENIPUNCTURE CDM","code_information":[{"code":"Px00030010004","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ROUTINE VENIPUNCTURE - REFERRAL DRAW FEE","code_information":[{"code":"Px00030010005","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ROUTINE VENIPUNCTURE - REFERRAL PROCESSING","code_information":[{"code":"Px00030010007","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":75.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLLECTION CAPILLARY BLOOD SPECIMEN","code_information":[{"code":"Px00030010011","type":"CDM"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":760.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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 FLU A FLU B AND RSV BY PCR","code_information":[{"code":"Px00030010068","type":"CDM"},{"code":"87631","type":"HCPCS"}],"standard_charges":[{"gross_charge":1649.0,"discounted_cash":577.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1071.0,"discounted_cash":374.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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: JV CPCT 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":3212.0,"discounted_cash":1124.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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 LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE CDM","code_information":[{"code":"Px00030010281","type":"CDM"},{"code":"89055","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"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":189.0,"discounted_cash":66.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":67.0,"discounted_cash":23.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":644.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":197.0,"discounted_cash":68.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC FLUORESCENT ANTIBODY TITER","code_information":[{"code":"Px00030010512","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.3,"discounted_cash":4.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - RDL"}]},{"description":"HC IMMUNOASSAY TUMOR CA 19-9","code_information":[{"code":"Px00030010558","type":"CDM"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":197.0,"discounted_cash":68.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 CDM","code_information":[{"code":"Px00030010560","type":"CDM"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":197.0,"discounted_cash":68.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS SERUM","code_information":[{"code":"Px00030010599","type":"CDM"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":1382.0,"discounted_cash":483.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":272.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH CDM","code_information":[{"code":"Px00030010660","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":132.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PARTICLE AGGLUTINATION TEST TITER EACH ANTIBODY","code_information":[{"code":"Px00030010673","type":"CDM"},{"code":"86406","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":138.0,"discounted_cash":48.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC RHEUMATOID FACTOR QUALITATIVE CDM","code_information":[{"code":"Px00030010675","type":"CDM"},{"code":"86430","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":69.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":62.0,"discounted_cash":21.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":51.0,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC HELICOBACTER PYLORI","code_information":[{"code":"Px00030010846","type":"CDM"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":98.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":104.0,"discounted_cash":36.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY CDM","code_information":[{"code":"Px00030010931","type":"CDM"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":104.0,"discounted_cash":36.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC INFLUENZA VIRUS ANTIBODY","code_information":[{"code":"Px00030010934","type":"CDM"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.0,"discounted_cash":190.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBEOLA CDM","code_information":[{"code":"Px00030010970","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":46.0,"discounted_cash":16.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ANTIBODY VARICELLA-ZOSTER CDM","code_information":[{"code":"Px00030011006","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":46.0,"discounted_cash":16.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":484.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":386.0,"discounted_cash":135.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":558.0,"discounted_cash":195.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":557.0,"discounted_cash":194.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC COOMBS TEST DIRECT - DAT EA ANTISERA","code_information":[{"code":"Px00030011063","type":"CDM"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":1313.0,"discounted_cash":459.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":167.0,"discounted_cash":58.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":254.0,"discounted_cash":88.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":167.0,"discounted_cash":58.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":484.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":286.0,"discounted_cash":100.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":180.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":216.0,"discounted_cash":75.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":607.0,"discounted_cash":212.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":607.0,"discounted_cash":212.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":557.0,"discounted_cash":194.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":479.0,"discounted_cash":167.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":315.0,"discounted_cash":110.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC COMPATIBILITY EACH UNIT ELECTRONIC LAB","code_information":[{"code":"Px00030011125","type":"CDM"},{"code":"86923","type":"HCPCS"}],"standard_charges":[{"gross_charge":641.0,"discounted_cash":224.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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 IRRADIATION BLOOD PRODUCT EACH UNIT LAB","code_information":[{"code":"Px00030011130","type":"CDM"},{"code":"86945","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":24.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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"}]},{"description":"HC SPECIMEN CONCENTRATION","code_information":[{"code":"Px00030011141","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":147.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":88.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC SPECIMEN CONCENTRATION - INFECT AGENT","code_information":[{"code":"Px00030011142","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":147.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":88.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CULTR BACTERIA EXCEPT BLOOD","code_information":[{"code":"Px00030011159","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1316.0,"discounted_cash":460.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":598.0,"discounted_cash":209.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":61.0,"discounted_cash":21.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OVA AND PARASITES SMEARS","code_information":[{"code":"Px00030011200","type":"CDM"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":767.0,"discounted_cash":268.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC SMEAR FLUORESCENT/ACID STAI","code_information":[{"code":"Px00030011226","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":689.0,"discounted_cash":241.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":989.0,"discounted_cash":346.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":248.0,"discounted_cash":86.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC SMEAR COMPLEX STAIN-TRICHROME/OVA/PARA","code_information":[{"code":"Px00030011257","type":"CDM"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":129.0,"discounted_cash":45.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC SMEAR WET MOUNT SALINE/INK - KOH EXAM","code_information":[{"code":"Px00030011260","type":"CDM"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC WET MOUNT NFCT AGT LAB","code_information":[{"code":"Px00030011261","type":"CDM"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC WET MOUNT NFCT AGT CDM","code_information":[{"code":"Px00030011262","type":"CDM"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":689.0,"discounted_cash":241.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY TOXIN OR ANTITOXIN","code_information":[{"code":"Px00030011274","type":"CDM"},{"code":"87230","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":541.0,"discounted_cash":189.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CRYPTOSPORIDIUM AG EIA","code_information":[{"code":"Px00030011355","type":"CDM"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":106.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":220.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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: JV CPCT 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":312.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BODY FLUID CELL COUNT W/ DIFFERENTIAL","code_information":[{"code":"Px00030011520","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BODY FLUID CELL COUNT W/ DIFFERENTIAL CSF","code_information":[{"code":"Px00030011521","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED CDM","code_information":[{"code":"Px00030011538","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":72.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":260.0,"discounted_cash":91.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC NASAL SMEAR EOSINOPHILS CDM","code_information":[{"code":"Px00030011609","type":"CDM"},{"code":"89190","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":218.0,"discounted_cash":76.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC NASAL SMEAR EOSINOPHILS CDM","code_information":[{"code":"Px00030011610","type":"CDM"},{"code":"89190","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":218.0,"discounted_cash":76.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA ADDTL LAB","code_information":[{"code":"Px00030011621","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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"},{"gross_charge":557.0,"discounted_cash":194.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN CDM","code_information":[{"code":"Px00030011646","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":406.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":495.0,"discounted_cash":173.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IAADIADOO INFLUENZA CDM","code_information":[{"code":"Px00030011697","type":"CDM"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":751.0,"discounted_cash":262.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED CDM","code_information":[{"code":"Px00030011703","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO STREPTOCOCCUS GROUP A LAB","code_information":[{"code":"Px00030011741","type":"CDM"},{"code":"87880","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":100.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":240.0,"discounted_cash":84.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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"}]},{"description":"HC ROM (AMNISURE)","code_information":[{"code":"Px00030011747","type":"CDM"},{"code":"84112","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RSV ANTIGEN","code_information":[{"code":"Px00030011748","type":"CDM"},{"code":"87807","type":"HCPCS"}],"standard_charges":[{"gross_charge":826.0,"discounted_cash":289.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":826.0,"discounted_cash":289.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CRYPTOSPORIDIUM AG","code_information":[{"code":"Px00030011891","type":"CDM"},{"code":"87272","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":56.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"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":881.0,"discounted_cash":308.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":598.0,"discounted_cash":209.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CATHETERIZE FOR URINE SPECIMEN P9612","code_information":[{"code":"Px00030011972","type":"CDM"},{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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 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":288.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SPECIFIC GRAVITY EXCEPT URINE","code_information":[{"code":"Px00030013003","type":"CDM"},{"code":"84315","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OCCULT BLOOD OTHER SOURCES","code_information":[{"code":"Px00030013006","type":"CDM"},{"code":"82271","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":73.0,"discounted_cash":25.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF MYOGLOBIN","code_information":[{"code":"Px00030013007","type":"CDM"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":62.0,"discounted_cash":21.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":198.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":73.0,"discounted_cash":25.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":216.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":90.0,"discounted_cash":31.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF C-PEPTIDE","code_information":[{"code":"Px00030013013","type":"CDM"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":107.0,"discounted_cash":37.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC FACTOR INHIBITOR TEST CDM","code_information":[{"code":"Px00030013028","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":2802.0,"discounted_cash":980.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":228.0,"discounted_cash":79.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF IGE","code_information":[{"code":"Px00030013033","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":134.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":91.0,"discounted_cash":31.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PROCALCITONIN (PCT) CDM","code_information":[{"code":"Px00030013086","type":"CDM"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":750.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL OTHER SOURCE","code_information":[{"code":"Px00030013090","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":117.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":197.0,"discounted_cash":68.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MANUAL CELL COUNT EACH","code_information":[{"code":"Px00030013096","type":"CDM"},{"code":"85032","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":138.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CALCIUM SERUM","code_information":[{"code":"Px00030013847","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":56.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":47.0,"discounted_cash":16.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF FERRITIN CDM","code_information":[{"code":"Px00030013881","type":"CDM"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":175.0,"discounted_cash":61.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF LIPASE CDM","code_information":[{"code":"Px00030013912","type":"CDM"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":163.0,"discounted_cash":57.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PROTHROMBIN TIME 85610","code_information":[{"code":"Px00030013952","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":209.0,"discounted_cash":73.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS CDM","code_information":[{"code":"Px00030013969","type":"CDM"},{"code":"85046","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SODIUM","code_information":[{"code":"Px00030013978","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":49.0,"discounted_cash":17.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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 ALPHA-FETOPROTEIN SERUM CDM","code_information":[{"code":"Px00030014113","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":103.0,"discounted_cash":36.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ALKALINE PHOS","code_information":[{"code":"Px00030014138","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":39.0,"discounted_cash":13.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC AMYLASE URINE","code_information":[{"code":"Px00030014228","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":142.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ASSAY TRANSFERRIN","code_information":[{"code":"Px00030014358","type":"CDM"},{"code":"84466","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.7,"discounted_cash":33.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030014447","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":640.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":258.0,"discounted_cash":90.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BUN","code_information":[{"code":"Px00030014459","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":150.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF C-PEPTIDE CDM","code_information":[{"code":"Px00030014462","type":"CDM"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":118.0,"discounted_cash":41.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CALCIUM IONIZED","code_information":[{"code":"Px00030014481","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CALCIUM IONIZED","code_information":[{"code":"Px00030014482","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":119.0,"discounted_cash":41.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CARBON DIOXIDE BICARBONATE CDM","code_information":[{"code":"Px00030014495","type":"CDM"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":49.0,"discounted_cash":17.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CBC WITH DIFF AUTO","code_information":[{"code":"Px00030014514","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":681.0,"discounted_cash":238.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":325.0,"discounted_cash":113.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN CEA CDM","code_information":[{"code":"Px00030014520","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":29.0,"discounted_cash":10.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CHLORIDE BLOOD","code_information":[{"code":"Px00030014542","type":"CDM"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":49.0,"discounted_cash":17.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CHLORIDE URINE","code_information":[{"code":"Px00030014544","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CK TOTAL","code_information":[{"code":"Px00030014566","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":148.0,"discounted_cash":51.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CK-MB","code_information":[{"code":"Px00030014567","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":146.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":215.0,"discounted_cash":75.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC COAGULATION TIME ACTIVATED","code_information":[{"code":"Px00030014580","type":"CDM"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLUMN CHROMOTOGRAPHY QUANT","code_information":[{"code":"Px00030014590","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"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":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":151.0,"discounted_cash":52.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CREATININE CLEARANCE-SERUM + URINE","code_information":[{"code":"Px00030014631","type":"CDM"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.0,"discounted_cash":198.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":257.0,"discounted_cash":89.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC DDIMER QUANT","code_information":[{"code":"Px00030014674","type":"CDM"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":313.0,"discounted_cash":109.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI CDM","code_information":[{"code":"Px00030014775","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":1074.0,"discounted_cash":375.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":138.0,"discounted_cash":48.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE CDM","code_information":[{"code":"Px00030014776","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":46.0,"discounted_cash":16.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ESTRADIOL","code_information":[{"code":"Px00030014796","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":122.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":220.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":82.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN CDM","code_information":[{"code":"Px00030014881","type":"CDM"},{"code":"82731","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":164.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FETAL/MATERNAL BLOOD SCREEN","code_information":[{"code":"Px00030014884","type":"CDM"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.0,"discounted_cash":226.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":331.0,"discounted_cash":115.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF FOLIC ACID SERUM CDM","code_information":[{"code":"Px00030014898","type":"CDM"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":119.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":136.0,"discounted_cash":47.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 FREE CDM","code_information":[{"code":"Px00030014932","type":"CDM"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":135.0,"discounted_cash":47.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF FREE THYROXINE CDM","code_information":[{"code":"Px00030014933","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":135.0,"discounted_cash":47.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GONADOTROPIN FOLLICLE STIMULATING HORMONE CDM","code_information":[{"code":"Px00030014937","type":"CDM"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":100.0,"discounted_cash":35.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GAMMA GT TOTAL","code_information":[{"code":"Px00030014949","type":"CDM"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":40.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":35.0,"discounted_cash":12.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GAMMAGLOBULIN IGA IGD IGG IGM EACH","code_information":[{"code":"Px00030014950","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":71.0,"discounted_cash":24.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GLUCOSE BODY FLUID OTHER THAN BLOOD","code_information":[{"code":"Px00030014981","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":40.0,"discounted_cash":14.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GLUCOSE QUANTITATIVE BLOOD (EXCEPT REAGENT STRIP)","code_information":[{"code":"Px00030014986","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":45.0,"discounted_cash":15.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEMOGLOBIN GLYCOSYLATED A1C CDM","code_information":[{"code":"Px00030015020","type":"CDM"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":62.0,"discounted_cash":21.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GONADOTROPIN CHORIONIC (HCG) QUANTITATIVE","code_information":[{"code":"Px00030015025","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":223.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":161.0,"discounted_cash":56.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF GROWTH HORMONE HUMAN CDM","code_information":[{"code":"Px00030015029","type":"CDM"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HAPTOGLOBIN QUANTITATIVE CDM","code_information":[{"code":"Px00030015036","type":"CDM"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":113.0,"discounted_cash":39.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GONADOTROPIN CHORIONIC QUALITATIVE CDM","code_information":[{"code":"Px00030015043","type":"CDM"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":161.0,"discounted_cash":56.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL CDM","code_information":[{"code":"Px00030015059","type":"CDM"},{"code":"83718","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":119.0,"discounted_cash":41.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEMATOCRIT (HCT)","code_information":[{"code":"Px00030015067","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":126.0,"discounted_cash":44.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEMOGLOBIN (HGB)","code_information":[{"code":"Px00030015080","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":376.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN CDM","code_information":[{"code":"Px00030015086","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":29.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IGE SERUM TOTAL","code_information":[{"code":"Px00030015213","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":150.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":101.0,"discounted_cash":35.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IRON","code_information":[{"code":"Px00030015298","type":"CDM"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":172.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IRON BINDING CAPACITY CDM","code_information":[{"code":"Px00030015300","type":"CDM"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":226.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF LACTATE","code_information":[{"code":"Px00030015357","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":150.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC LDH SERUM","code_information":[{"code":"Px00030015373","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":69.0,"discounted_cash":24.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL CDM","code_information":[{"code":"Px00030015375","type":"CDM"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":56.0,"discounted_cash":19.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GONADOTROPIN LUTEINIZING HORMONE CDM","code_information":[{"code":"Px00030015391","type":"CDM"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":100.0,"discounted_cash":35.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC LIOW CYCLOSPORINE","code_information":[{"code":"Px00030015394","type":"CDM"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"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"}]},{"description":"HC MAGNESIUM QUANT URINE","code_information":[{"code":"Px00030015421","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":184.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC NI METABOLIC SCREEN CDM","code_information":[{"code":"Px00030015575","type":"CDM"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":5.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PHOSPHORUS QUANT URINE","code_information":[{"code":"Px00030015691","type":"CDM"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BLOOD COUNT HEMATOCRIT","code_information":[{"code":"Px00030015718","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":29.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM SERUM PLASMA/WHOLE BLOOD","code_information":[{"code":"Px00030015732","type":"CDM"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":345.0,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":232.0,"discounted_cash":81.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM CDM","code_information":[{"code":"Px00030015763","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":1074.0,"discounted_cash":375.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":138.0,"discounted_cash":48.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":148.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":21.0,"discounted_cash":7.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1074.0,"discounted_cash":375.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":138.0,"discounted_cash":48.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL URINE PAMC","code_information":[{"code":"Px00030015783","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":163.0,"discounted_cash":57.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PSA FREE","code_information":[{"code":"Px00030015809","type":"CDM"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":75.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":79.0,"discounted_cash":27.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":322.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":209.0,"discounted_cash":73.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC RETICULATED PLATELET ASSAY CDM","code_information":[{"code":"Px00030015883","type":"CDM"},{"code":"85055","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":209.0,"discounted_cash":73.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC SGPT (ALT)","code_information":[{"code":"Px00030015931","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":57.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":38.0,"discounted_cash":13.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 CDM","code_information":[{"code":"Px00030015997","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":97.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":186.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC T3 UPTAKE","code_information":[{"code":"Px00030016000","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":97.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":153.0,"discounted_cash":53.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF FERRITIN CDM","code_information":[{"code":"Px00030016020","type":"CDM"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":175.0,"discounted_cash":61.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC THYROID STIMULATING HORMONE (TSH)","code_information":[{"code":"Px00030016041","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":203.0,"discounted_cash":71.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC THYROXINE T4","code_information":[{"code":"Px00030016044","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":135.0,"discounted_cash":47.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC TRIGLYCERIDES","code_information":[{"code":"Px00030016086","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":49.0,"discounted_cash":17.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC TROPONIN QUANTITATIVE","code_information":[{"code":"Px00030016091","type":"CDM"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":201.0,"discounted_cash":70.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC UREA QUANT URINE","code_information":[{"code":"Px00030016112","type":"CDM"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF URIC ACID OTHER SOURCE LAB","code_information":[{"code":"Px00030016119","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":151.0,"discounted_cash":52.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":356.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":136.0,"discounted_cash":47.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CLOSTRIDIUM DIFFICILE TOXINS AMPLIFIED PROBE","code_information":[{"code":"Px00030016255","type":"CDM"},{"code":"87493","type":"HCPCS"}],"standard_charges":[{"gross_charge":1394.0,"discounted_cash":487.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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 CONCENTRATION INFECTIOUS AGENTS CDM","code_information":[{"code":"Px00030016284","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":136.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":64.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":417.0,"discounted_cash":145.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":153.0,"discounted_cash":53.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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 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":468.0,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":373.0,"discounted_cash":130.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC DRUG ASSAY CARBAMAZEPINE -10 11-EPOXIDE LAB","code_information":[{"code":"Px00030100041","type":"CDM"},{"code":"80161","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.0,"discounted_cash":154.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":283.0,"discounted_cash":99.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC DRUG ASSAY SALICYLATE LAB","code_information":[{"code":"Px00030100043","type":"CDM"},{"code":"80179","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":373.0,"discounted_cash":130.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":639.0,"discounted_cash":223.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":444.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":122.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3","code_information":[{"code":"Px00030100119","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":97.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":186.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":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":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":135.0,"discounted_cash":47.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 LAB","code_information":[{"code":"Px00030100124","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":97.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":186.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 FREE LAB","code_information":[{"code":"Px00030100125","type":"CDM"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":135.0,"discounted_cash":47.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB","code_information":[{"code":"Px00030100126","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":223.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":161.0,"discounted_cash":56.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE LAB","code_information":[{"code":"Px00030100130","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":150.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":101.0,"discounted_cash":35.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":304.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":71.0,"discounted_cash":24.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":304.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":71.0,"discounted_cash":24.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":304.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":71.0,"discounted_cash":24.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF ESTRADIOL LAB","code_information":[{"code":"Px00030100136","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":122.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB","code_information":[{"code":"Px00030100137","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":223.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":161.0,"discounted_cash":56.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF ESTRADIOL LAB","code_information":[{"code":"Px00030100138","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":122.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE LAB","code_information":[{"code":"Px00030100142","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":150.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":101.0,"discounted_cash":35.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":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 IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100377","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.52,"discounted_cash":45.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100541","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":123.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100542","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":123.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE VANCOMYCIN LAB","code_information":[{"code":"Px00030100544","type":"CDM"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":1125.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":567.0,"discounted_cash":198.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ALBUMIN SERUM PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030100562","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":42.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":32.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN LAB","code_information":[{"code":"Px00030100563","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":39.0,"discounted_cash":13.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC URINE ALBUMIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100564","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":85.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":49.0,"discounted_cash":17.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM LAB","code_information":[{"code":"Px00030100566","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":103.0,"discounted_cash":36.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF AMYLASE LAB","code_information":[{"code":"Px00030100567","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":153.0,"discounted_cash":53.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF AMYLASE","code_information":[{"code":"Px00030100568","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":153.0,"discounted_cash":53.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF AMYLASE LAB","code_information":[{"code":"Px00030100569","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":153.0,"discounted_cash":53.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BILIRUBIN TOTAL LAB","code_information":[{"code":"Px00030100570","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":30.0,"discounted_cash":10.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BILIRUBIN TOTAL LAB","code_information":[{"code":"Px00030100571","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":30.0,"discounted_cash":10.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BILIRUBIN DIRECT LAB","code_information":[{"code":"Px00030100572","type":"CDM"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":45.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":30.0,"discounted_cash":10.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CALCIUM TOTAL LAB","code_information":[{"code":"Px00030100574","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":56.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":47.0,"discounted_cash":16.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CALCIUM URINE QUANTITATIVE TIMED SPECIMEN LAB","code_information":[{"code":"Px00030100575","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":151.0,"discounted_cash":52.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100580","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":151.0,"discounted_cash":52.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100581","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":151.0,"discounted_cash":52.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100582","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":151.0,"discounted_cash":52.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":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":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":376.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":148.0,"discounted_cash":51.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CREATINE KINASE MB FRACTION ONLY LAB","code_information":[{"code":"Px00030100587","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":146.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":215.0,"discounted_cash":75.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100589","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":135.0,"discounted_cash":47.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100590","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":135.0,"discounted_cash":47.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100591","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":135.0,"discounted_cash":47.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100592","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":189.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100593","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":189.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100594","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":189.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100595","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":189.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF ESTRADIOL LAB","code_information":[{"code":"Px00030100596","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":122.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":304.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":71.0,"discounted_cash":24.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":304.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":71.0,"discounted_cash":24.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":304.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":71.0,"discounted_cash":24.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE LAB","code_information":[{"code":"Px00030100608","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":134.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":91.0,"discounted_cash":31.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE","code_information":[{"code":"Px00030100609","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":150.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":101.0,"discounted_cash":35.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE LAB","code_information":[{"code":"Px00030100610","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":150.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":101.0,"discounted_cash":35.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF LIPASE LAB","code_information":[{"code":"Px00030100626","type":"CDM"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":163.0,"discounted_cash":57.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL LAB","code_information":[{"code":"Px00030100628","type":"CDM"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":56.0,"discounted_cash":19.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030100630","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":148.0,"discounted_cash":51.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030100631","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":148.0,"discounted_cash":51.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF PHOSPHATASE ALKALINE LAB","code_information":[{"code":"Px00030100632","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":39.0,"discounted_cash":13.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC POTASSIUM URINE LAB","code_information":[{"code":"Px00030100635","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":38.0,"discounted_cash":13.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":111.0,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":29.0,"discounted_cash":10.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030100639","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":163.0,"discounted_cash":57.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF URINE SODIUM LAB","code_information":[{"code":"Px00030100652","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":41.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":39.0,"discounted_cash":13.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030100655","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":100.0,"discounted_cash":35.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030100656","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":100.0,"discounted_cash":35.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030100657","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":100.0,"discounted_cash":35.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF THYROXINE TOTAL LAB","code_information":[{"code":"Px00030100658","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":135.0,"discounted_cash":47.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF FREE THYROXINE LAB","code_information":[{"code":"Px00030100659","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":135.0,"discounted_cash":47.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB","code_information":[{"code":"Px00030100660","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":203.0,"discounted_cash":71.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB","code_information":[{"code":"Px00030100661","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":203.0,"discounted_cash":71.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB","code_information":[{"code":"Px00030100662","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":203.0,"discounted_cash":71.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":279.0,"discounted_cash":97.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":153.0,"discounted_cash":53.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":279.0,"discounted_cash":97.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":153.0,"discounted_cash":53.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 LAB","code_information":[{"code":"Px00030100665","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":97.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":186.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF TROPONIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100666","type":"CDM"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":201.0,"discounted_cash":70.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF UREA NITROGEN QUANTITATIVE LAB","code_information":[{"code":"Px00030100667","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":150.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF BLOOD/URIC ACID LAB","code_information":[{"code":"Px00030100668","type":"CDM"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":151.0,"discounted_cash":52.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CHLORIDE URINE LAB","code_information":[{"code":"Px00030100761","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CREATINE KINASE MB FRACTION ONLY LAB","code_information":[{"code":"Px00030100762","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":146.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":215.0,"discounted_cash":75.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":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":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":151.0,"discounted_cash":52.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GLUCOSE BODY FLUID OTHER THAN BLOOD LAB","code_information":[{"code":"Px00030100765","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":40.0,"discounted_cash":14.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE LAB","code_information":[{"code":"Px00030100770","type":"CDM"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":75.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":79.0,"discounted_cash":27.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF TRIGLYCERIDES LAB","code_information":[{"code":"Px00030100771","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":49.0,"discounted_cash":17.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BILIRUBIN TOTAL LAB","code_information":[{"code":"Px00030100775","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":30.0,"discounted_cash":10.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN LAB","code_information":[{"code":"Px00030100777","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":39.0,"discounted_cash":13.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC DRUG ASSAY CARBAMAZEPINE TOTAL LAB","code_information":[{"code":"Px00030100818","type":"CDM"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":849.0,"discounted_cash":297.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100855","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":123.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100856","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":123.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030100862","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":163.0,"discounted_cash":57.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PROCALCITONIN (PCT) LAB","code_information":[{"code":"Px00030100967","type":"CDM"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":750.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE SODIUM LAB","code_information":[{"code":"Px00030101044","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":32.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB","code_information":[{"code":"Px00030101046","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":191.0,"discounted_cash":66.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101056","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":87.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101057","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":87.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101058","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":87.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101059","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":87.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101060","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":87.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101062","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":87.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":463.0,"discounted_cash":162.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS LAB","code_information":[{"code":"Px00030101066","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":162.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030101073","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":73.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":122.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF LACTATE LAB","code_information":[{"code":"Px00030101085","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":123.0,"discounted_cash":43.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF LACTATE LAB","code_information":[{"code":"Px00030101086","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":123.0,"discounted_cash":43.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101232","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":151.0,"discounted_cash":52.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101233","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":151.0,"discounted_cash":52.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TOBRAMYCIN CDM","code_information":[{"code":"Px00030101278","type":"CDM"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":567.0,"discounted_cash":198.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TOBRAMYCIN LAB","code_information":[{"code":"Px00030101279","type":"CDM"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":567.0,"discounted_cash":198.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030101322","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":46.0,"discounted_cash":16.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030101324","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":72.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":163.0,"discounted_cash":57.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":859.0,"discounted_cash":300.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":138.0,"discounted_cash":48.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF BLOOD/URIC ACID CDM","code_information":[{"code":"Px00030110077","type":"CDM"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":151.0,"discounted_cash":52.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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 GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMETRY","code_information":[{"code":"Px00030110102","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":1138.0,"discounted_cash":398.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES W/O2 SATURATION CDM","code_information":[{"code":"Px00030110103","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":1138.0,"discounted_cash":398.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":366.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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 DRUGS OF ABUSE URINE","code_information":[{"code":"Px00030110155","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":162.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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"},{"gross_charge":885.0,"discounted_cash":309.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":567.0,"discounted_cash":198.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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"},{"gross_charge":885.0,"discounted_cash":309.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":567.0,"discounted_cash":198.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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 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 ASSAY OF PARATHORMONE LAB","code_information":[{"code":"Px00030110189","type":"CDM"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":226.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS","code_information":[{"code":"Px00030110225","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - UC DAVIS"}]},{"description":"HC DRUG ASSAY CARBAMAZEPINE TOTAL LAB","code_information":[{"code":"Px00030110444","type":"CDM"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":1104.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":567.0,"discounted_cash":198.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1125.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":567.0,"discounted_cash":198.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CALCIUM URINE QUANTITATIVE TIMED SPECIMEN LAB","code_information":[{"code":"Px00030110534","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":133.0,"discounted_cash":46.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1125.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":567.0,"discounted_cash":198.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS CDM","code_information":[{"code":"Px00030110635","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":162.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":468.0,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":373.0,"discounted_cash":130.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GLUCOSE BLOOD REAGENT STRIP LAB","code_information":[{"code":"Px00030112001","type":"CDM"},{"code":"82948","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","code_information":[{"code":"Px00030112002","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":300.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SERUM ALBUMIN","code_information":[{"code":"Px00030112003","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":42.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":32.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC OCCULT BLOOD FECES","code_information":[{"code":"Px00030112004","type":"CDM"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":73.0,"discounted_cash":25.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF LACTIC ACID","code_information":[{"code":"Px00030112005","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":150.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CREATINE MB FRACTION","code_information":[{"code":"Px00030112006","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":146.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":215.0,"discounted_cash":75.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROPHORESIS OTHER FLUIDS","code_information":[{"code":"Px00030112007","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":125.0,"discounted_cash":43.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF UREA NITROGEN","code_information":[{"code":"Px00030112008","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":150.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF AMYLASE","code_information":[{"code":"Px00030112009","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":153.0,"discounted_cash":53.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF HAPTOGLOBIN QUANT","code_information":[{"code":"Px00030112013","type":"CDM"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":113.0,"discounted_cash":39.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF MAGNESIUM","code_information":[{"code":"Px00030112014","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":144.0,"discounted_cash":50.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF BLOOD CHLORIDE","code_information":[{"code":"Px00030112015","type":"CDM"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":49.0,"discounted_cash":17.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC SODIUM BLOOD","code_information":[{"code":"Px00030112016","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":49.0,"discounted_cash":17.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC THYROID STIMULATING HORMONE TSH","code_information":[{"code":"Px00030112017","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":203.0,"discounted_cash":71.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL LAB","code_information":[{"code":"Px00030112018","type":"CDM"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":56.0,"discounted_cash":19.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MICROALBUMIN QUANTITATIVE","code_information":[{"code":"Px00030112020","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":85.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":49.0,"discounted_cash":17.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BILIRUBIN TOTAL","code_information":[{"code":"Px00030112023","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":30.0,"discounted_cash":10.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC NATRIURETIC PEPTIDE","code_information":[{"code":"Px00030112024","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":148.0,"discounted_cash":51.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC TEST FOR ACETONE/KETONES","code_information":[{"code":"Px00030112025","type":"CDM"},{"code":"82009","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":119.0,"discounted_cash":41.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF TROPONIN QUANTITATIVE","code_information":[{"code":"Px00030112026","type":"CDM"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":201.0,"discounted_cash":70.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CALCIUM IONIZED","code_information":[{"code":"Px00030112027","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE CREATININE","code_information":[{"code":"Px00030112028","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":135.0,"discounted_cash":47.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEPATITIS ACUTE PANEL","code_information":[{"code":"Px00030112029","type":"CDM"},{"code":"80074","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ELECTROLYTE PANEL","code_information":[{"code":"Px00030112031","type":"CDM"},{"code":"80051","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":126.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM CDM","code_information":[{"code":"Px00030112032","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":103.0,"discounted_cash":36.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF FETAL FIBRONECTIN","code_information":[{"code":"Px00030112034","type":"CDM"},{"code":"82731","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":164.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":172.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":30.0,"discounted_cash":10.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF CREATININE","code_information":[{"code":"Px00030112042","type":"CDM"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":45.0,"discounted_cash":15.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BILIRUBIN DIRECT","code_information":[{"code":"Px00030112043","type":"CDM"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":45.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":30.0,"discounted_cash":10.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC OSMOLALITY URINE","code_information":[{"code":"Px00030112044","type":"CDM"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":119.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":192.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PREALBUMIN CDM","code_information":[{"code":"Px00030112045","type":"CDM"},{"code":"84134","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":118.0,"discounted_cash":41.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC DRUG ASSAY CARBAMAZEPINE TOTAL CDM","code_information":[{"code":"Px00030112046","type":"CDM"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":1104.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":567.0,"discounted_cash":198.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF URINE CHLORIDE","code_information":[{"code":"Px00030112047","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENOBARBITAL LAB","code_information":[{"code":"Px00030112050","type":"CDM"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":1125.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":567.0,"discounted_cash":198.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC POTASSIUM URINE","code_information":[{"code":"Px00030112055","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":38.0,"discounted_cash":13.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030112057","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":151.0,"discounted_cash":52.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC OSMOLALITY BLOOD","code_information":[{"code":"Px00030112058","type":"CDM"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":119.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":192.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PROSTATE SPECIFIC ANTIGEN TOTAL","code_information":[{"code":"Px00030112059","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":232.0,"discounted_cash":81.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CALCIUM TOTAL LAB","code_information":[{"code":"Px00030112060","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":56.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":47.0,"discounted_cash":16.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BASIC METABOLIC PANEL","code_information":[{"code":"Px00030112061","type":"CDM"},{"code":"80048","type":"HCPCS"}],"standard_charges":[{"gross_charge":1116.0,"discounted_cash":390.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":435.0,"discounted_cash":152.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC COMPREHEN METABOLIC PANEL","code_information":[{"code":"Px00030112062","type":"CDM"},{"code":"80053","type":"HCPCS"}],"standard_charges":[{"gross_charge":1253.0,"discounted_cash":438.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":480.0,"discounted_cash":168.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC LIPID PANEL","code_information":[{"code":"Px00030112063","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":857.0,"discounted_cash":299.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":353.0,"discounted_cash":123.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC RENAL FUNCTION PANEL CDM","code_information":[{"code":"Px00030112064","type":"CDM"},{"code":"80069","type":"HCPCS"}],"standard_charges":[{"gross_charge":1385.0,"discounted_cash":484.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":510.0,"discounted_cash":178.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC THYROXINE FREE","code_information":[{"code":"Px00030112065","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":135.0,"discounted_cash":47.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GLYCOSYLATED HEMOGLOBIN TEST","code_information":[{"code":"Px00030112066","type":"CDM"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":62.0,"discounted_cash":21.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF PROGESTERONE CDM","code_information":[{"code":"Px00030112067","type":"CDM"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":134.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":91.0,"discounted_cash":31.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GTT-ADDED SAMPLES","code_information":[{"code":"Px00030112068","type":"CDM"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":71.0,"discounted_cash":24.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF ESTRADIOL","code_information":[{"code":"Px00030112069","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":140.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE THEOPHYLLINE CDM","code_information":[{"code":"Px00030112071","type":"CDM"},{"code":"80198","type":"HCPCS"}],"standard_charges":[{"gross_charge":1148.0,"discounted_cash":401.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":655.0,"discounted_cash":229.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PHOSPHORUS URINE","code_information":[{"code":"Px00030112072","type":"CDM"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF PROLACTIN CDM","code_information":[{"code":"Px00030112073","type":"CDM"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":85.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":92.0,"discounted_cash":32.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY GROWTH HORMONE (HGH)","code_information":[{"code":"Px00030112080","type":"CDM"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE QUINIDINE CDM","code_information":[{"code":"Px00030112097","type":"CDM"},{"code":"80194","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.0,"discounted_cash":277.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":567.0,"discounted_cash":198.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY GLUCOSE BLOOD QUANT","code_information":[{"code":"Px00030112099","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":45.0,"discounted_cash":15.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF INSULIN TOTAL CDM","code_information":[{"code":"Px00030112100","type":"CDM"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":64.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":71.0,"discounted_cash":24.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC LACTATE (LD) (LDH) ENZYME","code_information":[{"code":"Px00030112101","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":69.0,"discounted_cash":24.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY BLOOD CARBON DIOXIDE","code_information":[{"code":"Px00030112102","type":"CDM"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":49.0,"discounted_cash":17.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEPATIC FUNCTION PANEL CDM","code_information":[{"code":"Px00030112103","type":"CDM"},{"code":"80076","type":"HCPCS"}],"standard_charges":[{"gross_charge":1632.0,"discounted_cash":571.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":307.0,"discounted_cash":107.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ALANINE AMINO (ALT) (SGPT)","code_information":[{"code":"Px00030112104","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":57.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":38.0,"discounted_cash":13.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF GGT","code_information":[{"code":"Px00030112105","type":"CDM"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":40.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":35.0,"discounted_cash":12.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BLOOD FOLIC ACID SERUM","code_information":[{"code":"Px00030112106","type":"CDM"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":119.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":136.0,"discounted_cash":47.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY PHOSPHORUS","code_information":[{"code":"Px00030112107","type":"CDM"},{"code":"84100","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":38.0,"discounted_cash":13.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF AMMONIA LAB","code_information":[{"code":"Px00030112108","type":"CDM"},{"code":"82140","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":150.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL CDM","code_information":[{"code":"Px00030112109","type":"CDM"},{"code":"80162","type":"HCPCS"}],"standard_charges":[{"gross_charge":1491.0,"discounted_cash":521.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":428.0,"discounted_cash":149.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF FERRITIN","code_information":[{"code":"Px00030112111","type":"CDM"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":175.0,"discounted_cash":61.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF IRON","code_information":[{"code":"Px00030112112","type":"CDM"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":172.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC FREE ASSAY (FT-3)","code_information":[{"code":"Px00030112114","type":"CDM"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":135.0,"discounted_cash":47.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC TESTOSTERONE TOTAL","code_information":[{"code":"Px00030112115","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":100.0,"discounted_cash":35.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE LITHIUM CDM","code_information":[{"code":"Px00030112116","type":"CDM"},{"code":"80178","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":303.0,"discounted_cash":106.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IRON BINDING CAPACITY LAB","code_information":[{"code":"Px00030112117","type":"CDM"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":226.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC THYROXINE TOTAL","code_information":[{"code":"Px00030112118","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":135.0,"discounted_cash":47.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GONADOTROPIN FOLLICLE STIMULATING HORMONE LAB","code_information":[{"code":"Px00030112119","type":"CDM"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":140.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":90.0,"discounted_cash":31.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GONADOTROPIN LUTEINIZING HORMONE LAB","code_information":[{"code":"Px00030112120","type":"CDM"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":140.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":90.0,"discounted_cash":31.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CALCIUM URINE QUANTITATIVE TIMED SPECIMEN CDM","code_information":[{"code":"Px00030112121","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN","code_information":[{"code":"Px00030112123","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":29.0,"discounted_cash":10.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF THYROID (T3 OR T4)","code_information":[{"code":"Px00030112125","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":97.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":153.0,"discounted_cash":53.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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 PHOSPHATIDYLGLYCEROL","code_information":[{"code":"Px00030112140","type":"CDM"},{"code":"84081","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":174.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIGLYCERIDES","code_information":[{"code":"Px00030112157","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":49.0,"discounted_cash":17.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF PHOSPHATASE ALKALINE LAB","code_information":[{"code":"Px00030112158","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":39.0,"discounted_cash":13.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF LIPASE","code_information":[{"code":"Px00030112159","type":"CDM"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":163.0,"discounted_cash":57.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF CK (CPK)","code_information":[{"code":"Px00030112160","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":148.0,"discounted_cash":51.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PARATHORMONE (PARATHYROID HORMONE)","code_information":[{"code":"Px00030112161","type":"CDM"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":226.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC TRANSFERASE ASPARTATE AMINO AST SGOT","code_information":[{"code":"Px00030112162","type":"CDM"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":38.0,"discounted_cash":13.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF GENTAMICIN","code_information":[{"code":"Px00030112164","type":"CDM"},{"code":"80170","type":"HCPCS"}],"standard_charges":[{"gross_charge":1104.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":567.0,"discounted_cash":198.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PROSTATE SPECIFIC ANTIGEN FREE","code_information":[{"code":"Px00030112165","type":"CDM"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":71.0,"discounted_cash":24.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC VITAMIN B-12","code_information":[{"code":"Px00030112166","type":"CDM"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":136.0,"discounted_cash":47.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":111.0,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":29.0,"discounted_cash":10.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CREATININE CLEARANCE TEST","code_information":[{"code":"Px00030112169","type":"CDM"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.0,"discounted_cash":198.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":257.0,"discounted_cash":89.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC SODIUM URINE","code_information":[{"code":"Px00030112172","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":41.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":39.0,"discounted_cash":13.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL CDM","code_information":[{"code":"Px00030112174","type":"CDM"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":1125.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":562.0,"discounted_cash":196.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ACETONE ASSAY","code_information":[{"code":"Px00030112184","type":"CDM"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":142.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE OTHER FLUID","code_information":[{"code":"Px00030112189","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":40.0,"discounted_cash":14.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY TRIIODOTHYRONINE (T3)","code_information":[{"code":"Px00030112193","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":97.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":186.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY BLD/SERUM CHOLESTEROL","code_information":[{"code":"Px00030112194","type":"CDM"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":56.0,"discounted_cash":19.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF HOMOCYSTEINE LAB","code_information":[{"code":"Px00030112195","type":"CDM"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":118.0,"discounted_cash":41.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":140.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":45.0,"discounted_cash":15.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL CDM","code_information":[{"code":"Px00030112228","type":"CDM"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1085.0,"discounted_cash":379.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":567.0,"discounted_cash":198.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC POTASSIUM","code_information":[{"code":"Px00030112229","type":"CDM"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":51.0,"discounted_cash":17.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF URINE/UREA-N","code_information":[{"code":"Px00030112231","type":"CDM"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CREATININE BODY FLUID LAB","code_information":[{"code":"Px00030112238","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":189.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF MAGNESIUM CDM","code_information":[{"code":"Px00030112248","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":144.0,"discounted_cash":50.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CHOLESTEROL","code_information":[{"code":"Px00030112251","type":"CDM"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":56.0,"discounted_cash":19.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC UREA NITROGEN CLEARANCE LAB","code_information":[{"code":"Px00030112261","type":"CDM"},{"code":"84545","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"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 AMYLASE","code_information":[{"code":"Px00030112298","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":153.0,"discounted_cash":53.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF HOMOCYSTEINE LAB","code_information":[{"code":"Px00030112310","type":"CDM"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC TOTAL PROTEIN","code_information":[{"code":"Px00030112314","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":29.0,"discounted_cash":10.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MUCIN SYNOVIAL FLUID ROPES TEST LAB","code_information":[{"code":"Px00030112322","type":"CDM"},{"code":"83872","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":6.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PH URINE","code_information":[{"code":"Px00030112332","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":57.0,"discounted_cash":19.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PROCAINAMIDE","code_information":[{"code":"Px00030112333","type":"CDM"},{"code":"80190","type":"HCPCS"}],"standard_charges":[{"gross_charge":1125.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":644.0,"discounted_cash":225.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC TESTOSTERONE","code_information":[{"code":"Px00030112336","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":111.0,"discounted_cash":38.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF AMYLASE FLUID","code_information":[{"code":"Px00030112342","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":142.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":153.0,"discounted_cash":53.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY AMYLASE URINE","code_information":[{"code":"Px00030112344","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":142.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":153.0,"discounted_cash":53.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN","code_information":[{"code":"Px00030112351","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":39.0,"discounted_cash":13.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE","code_information":[{"code":"Px00030112358","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":189.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC LDH FLUID","code_information":[{"code":"Px00030112369","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":69.0,"discounted_cash":24.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF OSMOLALITY BLOOD","code_information":[{"code":"Px00030112375","type":"CDM"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":119.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":192.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC SGOT (AST)","code_information":[{"code":"Px00030112384","type":"CDM"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":38.0,"discounted_cash":13.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL URINE","code_information":[{"code":"Px00030112394","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":163.0,"discounted_cash":57.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF AMIKACIN","code_information":[{"code":"Px00030112403","type":"CDM"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":885.0,"discounted_cash":309.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":567.0,"discounted_cash":198.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL CSF","code_information":[{"code":"Px00030112411","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":117.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":197.0,"discounted_cash":68.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GLUCOSE BODY FLUID OTHER THAN BLOOD CDM","code_information":[{"code":"Px00030112504","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE TOLERANCE(3 SPECIMENS)","code_information":[{"code":"Px00030112505","type":"CDM"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":270.0,"discounted_cash":94.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GLUCOSE TEST 1HR PP LAB","code_information":[{"code":"Px00030112506","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"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":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":151.0,"discounted_cash":52.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MAGNESIUM-URINE","code_information":[{"code":"Px00030112607","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":184.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC TSH","code_information":[{"code":"Px00030112660","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":203.0,"discounted_cash":71.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CALCIUM (24HR UR)","code_information":[{"code":"Px00030112697","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":119.0,"discounted_cash":41.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CHLORIDE 24 HR URINE LAB","code_information":[{"code":"Px00030112700","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CREATININE (24HR UR)","code_information":[{"code":"Px00030112705","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":39.0,"discounted_cash":13.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC FETAL HEMOGLOBIN CHEMICAL","code_information":[{"code":"Px00030112710","type":"CDM"},{"code":"83030","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE TOLERANCE(3 SPEC)","code_information":[{"code":"Px00030112719","type":"CDM"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":270.0,"discounted_cash":94.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC LDH BODY FLUID","code_information":[{"code":"Px00030112736","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":69.0,"discounted_cash":24.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PH (BODY FLUID)","code_information":[{"code":"Px00030112756","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":30.0,"discounted_cash":10.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":123.0,"discounted_cash":43.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CALCIUM URINE QUANTITATIVE TIMED SPECIMEN CDM","code_information":[{"code":"Px00030113075","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CHLORIDE BLD CDM","code_information":[{"code":"Px00030113102","type":"CDM"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1138.0,"discounted_cash":398.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1138.0,"discounted_cash":398.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GESTATIONAL GLUCOSE 1 HOUR","code_information":[{"code":"Px00030113354","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE QUANT URINE","code_information":[{"code":"Px00030113378","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":61.0,"discounted_cash":21.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GLUCOSE URINE LAB","code_information":[{"code":"Px00030113387","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":61.0,"discounted_cash":21.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GONADOTROPIN CHORIONIC QUALITATIVE","code_information":[{"code":"Px00030113411","type":"CDM"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":161.0,"discounted_cash":56.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF IRON CDM","code_information":[{"code":"Px00030113527","type":"CDM"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":172.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF LACTATE","code_information":[{"code":"Px00030113541","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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 MAGNESIUM 24HR URINE","code_information":[{"code":"Px00030113584","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":184.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF MAGNESIUM CDM","code_information":[{"code":"Px00030113587","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":184.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF PHOSPHORUS INORGANIC URINE","code_information":[{"code":"Px00030113750","type":"CDM"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC POTASSIUM URINE TIMED","code_information":[{"code":"Px00030113777","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PROTEIN FLUID","code_information":[{"code":"Px00030113820","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":117.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":197.0,"discounted_cash":68.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC SODIUM SERUM PLASMA OR WHOLE BLOOD CDM","code_information":[{"code":"Px00030114097","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE SODIUM","code_information":[{"code":"Px00030114100","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":163.0,"discounted_cash":57.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TOBRAMYCIN CDM","code_information":[{"code":"Px00030114183","type":"CDM"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1125.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":567.0,"discounted_cash":198.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF TRIGLYCERIDES","code_information":[{"code":"Px00030114198","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":49.0,"discounted_cash":17.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC TSH REFLEX TO FT4","code_information":[{"code":"Px00030114208","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":206.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":71.0,"discounted_cash":24.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF URIC ACID OTHER SOURCE","code_information":[{"code":"Px00030114229","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":168.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ASSAY OF URIC ACID OTHER SOURCE CDM","code_information":[{"code":"Px00030114230","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":151.0,"discounted_cash":52.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC URIC ACID URINE 24HR","code_information":[{"code":"Px00030114231","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":151.0,"discounted_cash":52.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ANALGESICS NON-OPIOID 1 OR 2 ACETAMINOPHEN","code_information":[{"code":"Px00030114302","type":"CDM"},{"code":"80329","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":373.0,"discounted_cash":130.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":806.0,"discounted_cash":282.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":320.0,"discounted_cash":112.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR ALCOHOL PER DOS","code_information":[{"code":"Px00030114383","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":162.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"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":154.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":46.0,"discounted_cash":16.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200124","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.29,"discounted_cash":4.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - RDL"},{"gross_charge":284.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":91.0,"discounted_cash":31.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200125","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.29,"discounted_cash":4.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - RDL"},{"gross_charge":284.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":91.0,"discounted_cash":31.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ANTIBODY MUMPS LAB","code_information":[{"code":"Px00030200130","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":46.0,"discounted_cash":16.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB","code_information":[{"code":"Px00030200132","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":113.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB","code_information":[{"code":"Px00030200133","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":113.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200136","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.29,"discounted_cash":4.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - RDL"},{"gross_charge":284.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":91.0,"discounted_cash":31.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH LAB","code_information":[{"code":"Px00030200152","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":132.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY LAB","code_information":[{"code":"Px00030200153","type":"CDM"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":104.0,"discounted_cash":36.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":669.0,"discounted_cash":234.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":116.0,"discounted_cash":40.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200502","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":234.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":116.0,"discounted_cash":40.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC C-REACTIVE PROTEIN LAB","code_information":[{"code":"Px00030200504","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":105.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":190.0,"discounted_cash":66.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC C-REACTIVE PROTEIN LAB","code_information":[{"code":"Px00030200505","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":105.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":190.0,"discounted_cash":66.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS SERUM LAB","code_information":[{"code":"Px00030200526","type":"CDM"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":1382.0,"discounted_cash":483.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":272.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS SERUM LAB","code_information":[{"code":"Px00030200527","type":"CDM"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":1245.0,"discounted_cash":435.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":245.0,"discounted_cash":85.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS LAB","code_information":[{"code":"Px00030200530","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":1382.0,"discounted_cash":483.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":272.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC RHEUMATOID FACTOR QUANTITATIVE LAB","code_information":[{"code":"Px00030200537","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":64.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":62.0,"discounted_cash":21.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC RHEUMATOID FACTOR QUANTITATIVE LAB","code_information":[{"code":"Px00030200538","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":64.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":62.0,"discounted_cash":21.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC RHEUMATOID FACTOR QUANTITATIVE LAB","code_information":[{"code":"Px00030200539","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":64.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":62.0,"discounted_cash":21.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB","code_information":[{"code":"Px00030200543","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":113.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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 IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS LAB","code_information":[{"code":"Px00030200680","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":1382.0,"discounted_cash":483.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":272.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","code_information":[{"code":"Px00030200681","type":"CDM"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":104.0,"discounted_cash":36.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB LAB","code_information":[{"code":"Px00030200682","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":210.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":104.0,"discounted_cash":36.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEPATITIS C ANTIBODY LAB","code_information":[{"code":"Px00030200683","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.0,"discounted_cash":262.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB LAB","code_information":[{"code":"Px00030200686","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":210.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":104.0,"discounted_cash":36.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEPATITIS C ANTIBODY LAB","code_information":[{"code":"Px00030200688","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.0,"discounted_cash":262.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEPATITIS C ANTIBODY","code_information":[{"code":"Px00030200689","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.0,"discounted_cash":262.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ANTIBODY MUMPS LAB","code_information":[{"code":"Px00030200994","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":46.0,"discounted_cash":16.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ANTIBODY MUMPS LAB","code_information":[{"code":"Px00030200995","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":46.0,"discounted_cash":16.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":104.0,"discounted_cash":36.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB LAB","code_information":[{"code":"Px00030201044","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":210.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":104.0,"discounted_cash":36.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB LAB","code_information":[{"code":"Px00030201046","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":210.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":104.0,"discounted_cash":36.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEPATITIS C ANTIBODY LAB","code_information":[{"code":"Px00030201057","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.0,"discounted_cash":262.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY CDM","code_information":[{"code":"Px00030210068","type":"CDM"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":189.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":95.0,"discounted_cash":33.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM CDM","code_information":[{"code":"Px00030210074","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GAMMAGLOBULIN IGM","code_information":[{"code":"Px00030210101","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":63.0,"discounted_cash":22.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":272.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":63.0,"discounted_cash":22.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC GAMMAGLOBULIN IGG","code_information":[{"code":"Px00030210105","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":63.0,"discounted_cash":22.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":318.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"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 IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY","code_information":[{"code":"Px00030210229","type":"CDM"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - UC DAVIS"}]},{"description":"HC DNA ANTIBODY SINGLE STRANDED LAB","code_information":[{"code":"Px00030210239","type":"CDM"},{"code":"86226","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST QUANTITATIVE LAB","code_information":[{"code":"Px00030210272","type":"CDM"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":113.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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 COMPATIBILITY EACH UNIT INCUBATION","code_information":[{"code":"Px00030210320","type":"CDM"},{"code":"86921","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"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":485.0,"discounted_cash":169.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":28.0,"discounted_cash":9.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ANTINUCLEAR ANTIBODIES (ANA) TITER","code_information":[{"code":"Px00030210354","type":"CDM"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":219.0,"discounted_cash":76.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA TITER LAB","code_information":[{"code":"Px00030210357","type":"CDM"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.3,"discounted_cash":4.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - RDL"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030210368","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.3,"discounted_cash":4.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - RDL"},{"gross_charge":667.0,"discounted_cash":233.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":116.0,"discounted_cash":40.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ANTINUCLEAR ANTIBODIES - ANA","code_information":[{"code":"Px00030210369","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":234.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":116.0,"discounted_cash":40.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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 C-REACTIVE PROTEIN","code_information":[{"code":"Px00030210399","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":105.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":190.0,"discounted_cash":66.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":389.0,"discounted_cash":136.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":331.0,"discounted_cash":115.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC COMPLEMENT ANTIGEN","code_information":[{"code":"Px00030210459","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.29,"discounted_cash":4.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - RDL"},{"gross_charge":284.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":91.0,"discounted_cash":31.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED CDM","code_information":[{"code":"Px00030210479","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.29,"discounted_cash":4.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - RDL"},{"gross_charge":77.0,"discounted_cash":26.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12.29,"discounted_cash":4.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - RDL"},{"gross_charge":101.0,"discounted_cash":35.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RHEUMATOID FACTOR QUANT","code_information":[{"code":"Px00030210522","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":64.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":62.0,"discounted_cash":21.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":396.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":249.0,"discounted_cash":87.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS","code_information":[{"code":"Px00030210547","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":173.0,"discounted_cash":60.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":604.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":104.0,"discounted_cash":36.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PARTICLE AGGLUTINATION TEST","code_information":[{"code":"Px00030210578","type":"CDM"},{"code":"86403","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.0,"discounted_cash":266.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREP QUAL","code_information":[{"code":"Px00030210605","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":113.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL CDM","code_information":[{"code":"Px00030210608","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":113.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"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":424.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":116.0,"discounted_cash":40.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HIV-1/HIV-2 SINGLE ASSAY","code_information":[{"code":"Px00030210719","type":"CDM"},{"code":"86703","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":116.0,"discounted_cash":40.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB CDM","code_information":[{"code":"Px00030210735","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":210.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":104.0,"discounted_cash":36.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC ANTIBODY MUMPS CDM","code_information":[{"code":"Px00030210745","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":46.0,"discounted_cash":16.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC RUBELLA ANTIBODY","code_information":[{"code":"Px00030210766","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":59.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":52.0,"discounted_cash":18.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEPATITIS C ANTIBODY CDM","code_information":[{"code":"Px00030210798","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.0,"discounted_cash":262.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":195.0,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":170.0,"discounted_cash":59.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE LAB","code_information":[{"code":"Px00030210867","type":"CDM"},{"code":"86920","type":"HCPCS"}],"standard_charges":[{"gross_charge":479.0,"discounted_cash":167.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PLASMA FRESH FROZEN","code_information":[{"code":"Px00030210874","type":"CDM"},{"code":"86927","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":244.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2517.0,"discounted_cash":880.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1085.0,"discounted_cash":379.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC SYPHILIS TEST NON-TREP QUAL - CSF","code_information":[{"code":"Px00030210935","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":113.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"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 DETECT AGENT NOS-DNA AMPLIFIED PROBE","code_information":[{"code":"Px00030210995","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IADNA INFLUENZA RSV AMP PROBE TQ EA ORG CDM","code_information":[{"code":"Px00030211059","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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 SERUM","code_information":[{"code":"Px00030211078","type":"CDM"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":1245.0,"discounted_cash":435.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":245.0,"discounted_cash":85.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IMMUNOFIXATION URINE","code_information":[{"code":"Px00030211079","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":1382.0,"discounted_cash":483.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":272.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":137.0,"discounted_cash":47.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INFLUENZA A-B PCR","code_information":[{"code":"Px00030211511","type":"CDM"},{"code":"87502","type":"HCPCS"}],"standard_charges":[{"gross_charge":1268.0,"discounted_cash":443.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":823.0,"discounted_cash":288.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC THROMBIN TIME PLASMA","code_information":[{"code":"Px00030500038","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":295.0,"discounted_cash":103.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BLOOD COUNT HEMATOCRIT LAB","code_information":[{"code":"Px00030500136","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":126.0,"discounted_cash":44.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BLOOD COUNT HEMATOCRIT","code_information":[{"code":"Px00030500137","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":126.0,"discounted_cash":44.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN","code_information":[{"code":"Px00030500138","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":681.0,"discounted_cash":238.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":325.0,"discounted_cash":113.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","code_information":[{"code":"Px00030500142","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":681.0,"discounted_cash":238.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":325.0,"discounted_cash":113.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030500144","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":640.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":258.0,"discounted_cash":90.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030500145","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":640.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":258.0,"discounted_cash":90.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030500146","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":640.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":258.0,"discounted_cash":90.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED LAB","code_information":[{"code":"Px00030500147","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":640.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":258.0,"discounted_cash":90.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BLOOD COUNT PLATELET AUTOMATED LAB","code_information":[{"code":"Px00030500148","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":108.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":126.0,"discounted_cash":44.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC RETICULATED PLATELET ASSAY","code_information":[{"code":"Px00030500151","type":"CDM"},{"code":"85055","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":209.0,"discounted_cash":73.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC RETICULATED PLATELET ASSAY","code_information":[{"code":"Px00030500152","type":"CDM"},{"code":"85055","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":592.0,"discounted_cash":207.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":313.0,"discounted_cash":109.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030500169","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":207.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":313.0,"discounted_cash":109.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030500214","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":209.0,"discounted_cash":73.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BLOOD COUNT HEMATOCRIT LAB","code_information":[{"code":"Px00030500243","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":136.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":101.0,"discounted_cash":35.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN LAB","code_information":[{"code":"Px00030500244","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030510005","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":209.0,"discounted_cash":73.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030510006","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":207.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":313.0,"discounted_cash":109.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEMOGLOBIN","code_information":[{"code":"Px00030510023","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC HEMATOCRIT","code_information":[{"code":"Px00030510024","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":126.0,"discounted_cash":44.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BLEEDING TIME TEST LAB","code_information":[{"code":"Px00030510025","type":"CDM"},{"code":"85002","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":313.0,"discounted_cash":109.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MANUAL RETICULOCYTE COUNT","code_information":[{"code":"Px00030510026","type":"CDM"},{"code":"85044","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":209.0,"discounted_cash":73.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC RBC SED RATE NONAUTOMATED","code_information":[{"code":"Px00030510027","type":"CDM"},{"code":"85651","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":126.0,"discounted_cash":44.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":681.0,"discounted_cash":238.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":325.0,"discounted_cash":113.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC AUTOMATED PLATELET COUNT","code_information":[{"code":"Px00030510030","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":108.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":126.0,"discounted_cash":44.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PROTHROMBIN TIME","code_information":[{"code":"Px00030510032","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":209.0,"discounted_cash":73.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL","code_information":[{"code":"Px00030510033","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":207.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":313.0,"discounted_cash":109.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEMOGLOBIN FETAL","code_information":[{"code":"Px00030510036","type":"CDM"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.0,"discounted_cash":226.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":331.0,"discounted_cash":115.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC HEPARIN ASSAY","code_information":[{"code":"Px00030510038","type":"CDM"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"discounted_cash":222.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"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 WBC ALKALINE PHOSPHATASE","code_information":[{"code":"Px00030510048","type":"CDM"},{"code":"85540","type":"HCPCS"}],"standard_charges":[{"gross_charge":1235.0,"discounted_cash":432.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":264.0,"discounted_cash":92.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC THROMBIN TIME","code_information":[{"code":"Px00030510050","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":295.0,"discounted_cash":103.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":512.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":313.0,"discounted_cash":109.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC COMPLETE CBC AUTOMATED","code_information":[{"code":"Px00030510062","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":640.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":258.0,"discounted_cash":90.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC FIBRINOGEN","code_information":[{"code":"Px00030510063","type":"CDM"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":295.0,"discounted_cash":103.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC FIBRINOGEN TEST LAB","code_information":[{"code":"Px00030510064","type":"CDM"},{"code":"85366","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":313.0,"discounted_cash":109.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC FIBRIN DEGRADATION QUANT","code_information":[{"code":"Px00030510069","type":"CDM"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":313.0,"discounted_cash":109.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC BLOOD CLOT FACTOR VIII TEST FACTOR","code_information":[{"code":"Px00030510072","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1097.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":344.0,"discounted_cash":120.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC RBC SED RATE AUTOMATED","code_information":[{"code":"Px00030510076","type":"CDM"},{"code":"85652","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":126.0,"discounted_cash":44.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PLATELET COUNT","code_information":[{"code":"Px00030510082","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":108.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":126.0,"discounted_cash":44.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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 PLATELET AGGREGATION EA AGENT","code_information":[{"code":"Px00030510217","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.0,"discounted_cash":269.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WBC AUTO","code_information":[{"code":"Px00030510310","type":"CDM"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":108.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":126.0,"discounted_cash":44.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CORONAVIRUS AG IA LAB","code_information":[{"code":"Px00030600007","type":"CDM"},{"code":"87426","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":151.0,"discounted_cash":52.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3164.0,"discounted_cash":1107.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 3-5 TARGETS","code_information":[{"code":"Px00030600044","type":"CDM"},{"code":"87631","type":"HCPCS"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":385.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":423.0,"discounted_cash":148.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":333.0,"discounted_cash":116.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600187","type":"CDM"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":94.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SARSCOV2 & INF A&B AMP PRB LAB","code_information":[{"code":"Px00030600318","type":"CDM"},{"code":"87636","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.0,"discounted_cash":296.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":881.0,"discounted_cash":308.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":598.0,"discounted_cash":209.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":881.0,"discounted_cash":308.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":598.0,"discounted_cash":209.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":881.0,"discounted_cash":308.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":598.0,"discounted_cash":209.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":881.0,"discounted_cash":308.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":598.0,"discounted_cash":209.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":881.0,"discounted_cash":308.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":598.0,"discounted_cash":209.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":513.0,"discounted_cash":179.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":79.0,"discounted_cash":27.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":513.0,"discounted_cash":179.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":79.0,"discounted_cash":27.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":513.0,"discounted_cash":179.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":79.0,"discounted_cash":27.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE LAB","code_information":[{"code":"Px00030600372","type":"CDM"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":733.0,"discounted_cash":256.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":598.0,"discounted_cash":209.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":689.0,"discounted_cash":241.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC TOXIN/ANTITOXIN ASSAY TISSUE CULTURE LAB","code_information":[{"code":"Px00030600379","type":"CDM"},{"code":"87230","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":541.0,"discounted_cash":189.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600380","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":406.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IAAD IA RESPIRATORY SYNCTIAL VIRUS LAB","code_information":[{"code":"Px00030600382","type":"CDM"},{"code":"87420","type":"HCPCS"}],"standard_charges":[{"gross_charge":826.0,"discounted_cash":289.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IAAD IA RESPIRATORY SYNCTIAL VIRUS","code_information":[{"code":"Px00030600383","type":"CDM"},{"code":"87420","type":"HCPCS"}],"standard_charges":[{"gross_charge":826.0,"discounted_cash":289.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030600403","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":495.0,"discounted_cash":173.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030600404","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":495.0,"discounted_cash":173.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030600405","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":495.0,"discounted_cash":173.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600431","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":406.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600432","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":406.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":881.0,"discounted_cash":308.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":598.0,"discounted_cash":209.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC TOXIN/ANTITOXIN ASSAY TISSUE CULTURE","code_information":[{"code":"Px00030600449","type":"CDM"},{"code":"87230","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":541.0,"discounted_cash":189.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":689.0,"discounted_cash":241.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600607","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600608","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600736","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":203.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":406.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ LAB","code_information":[{"code":"Px00030600758","type":"CDM"},{"code":"87637","type":"HCPCS"}],"standard_charges":[{"gross_charge":1600.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600763","type":"CDM"},{"code":"87636","type":"HCPCS"}],"standard_charges":[{"gross_charge":1908.0,"discounted_cash":667.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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 HELICOBACTER PYLORI FECAL ANTIGEN","code_information":[{"code":"Px00030610053","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":495.0,"discounted_cash":173.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ","code_information":[{"code":"Px00030610056","type":"CDM"},{"code":"87651","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":122.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":699.0,"discounted_cash":244.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":1951.0,"discounted_cash":682.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IADNA RESPIRATRY PROBE AND REV TRNSCR 21 TARGET PLA BIOFIRE PLA 0100","code_information":[{"code":"Px00030610083","type":"CDM"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":3212.0,"discounted_cash":1124.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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 CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ BIOFIRE PLA 0100ULAB","code_information":[{"code":"Px00030610091","type":"CDM"},{"code":"87486","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ BIOFIRE PLA 0100ULAB","code_information":[{"code":"Px00030610093","type":"CDM"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"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 KOH EXAM","code_information":[{"code":"Px00030610122","type":"CDM"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":153.0,"discounted_cash":53.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PARASITE ID","code_information":[{"code":"Px00030610134","type":"CDM"},{"code":"87169","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":138.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IAAD IA ROTAVIRUS CDM","code_information":[{"code":"Px00030610142","type":"CDM"},{"code":"87425","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ROTOVIRUS ANTIGEN","code_information":[{"code":"Px00030610143","type":"CDM"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 21 TARGET BIOFIRE PLA 0100ULAB","code_information":[{"code":"Px00030610152","type":"CDM"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":3212.0,"discounted_cash":1124.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IAAD IA MULT STEP METHOD NOS EACH ORGANISM","code_information":[{"code":"Px00030610178","type":"CDM"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM BIOFIRE PLA 0100ULAB","code_information":[{"code":"Px00030610182","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM BIOFIRE PLA 0100ULAB","code_information":[{"code":"Px00030610183","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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 BLOOD CULTURE FOR BACTERIA","code_information":[{"code":"Px00030610301","type":"CDM"},{"code":"87040","type":"HCPCS"}],"standard_charges":[{"gross_charge":982.0,"discounted_cash":343.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":460.0,"discounted_cash":161.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":270.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":109.0,"discounted_cash":38.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":270.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":109.0,"discounted_cash":38.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CULTURE BACTERIA OTHER","code_information":[{"code":"Px00030610321","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":881.0,"discounted_cash":308.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":598.0,"discounted_cash":209.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CULTURE BACTERIA OTHER - MISC/OTHER/ROUTINE","code_information":[{"code":"Px00030610340","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1054.0,"discounted_cash":368.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":598.0,"discounted_cash":209.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":429.0,"discounted_cash":150.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":303.0,"discounted_cash":106.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL","code_information":[{"code":"Px00030610359","type":"CDM"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":143.0,"discounted_cash":50.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CULTURE SCREEN ONLY - CLO TEST","code_information":[{"code":"Px00030610381","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":92.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":204.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CULTURE SCREEN ONLY","code_information":[{"code":"Px00030610387","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":179.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":79.0,"discounted_cash":27.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CULTURE SCREEN ONLY - STREP REFLEX","code_information":[{"code":"Px00030610388","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":1054.0,"discounted_cash":368.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":598.0,"discounted_cash":209.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CULTURE SCREEN ONLY - MRSA /MSSA","code_information":[{"code":"Px00030610391","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":178.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":513.0,"discounted_cash":179.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":79.0,"discounted_cash":27.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":569.0,"discounted_cash":199.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":88.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CULTURE-ANTIB RESIST ORG","code_information":[{"code":"Px00030610407","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":881.0,"discounted_cash":308.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":598.0,"discounted_cash":209.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC URINE CULTURE/COLONY COUNT","code_information":[{"code":"Px00030610417","type":"CDM"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":733.0,"discounted_cash":256.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":598.0,"discounted_cash":209.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC FUNGUS ISOLATION CULTURE - YEAST","code_information":[{"code":"Px00030610421","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":129.0,"discounted_cash":45.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC FUNGUS ISOLATION CULTURE","code_information":[{"code":"Px00030610423","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":1017.0,"discounted_cash":355.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":157.0,"discounted_cash":54.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1017.0,"discounted_cash":355.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":157.0,"discounted_cash":54.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":745.0,"discounted_cash":260.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":129.0,"discounted_cash":45.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD","code_information":[{"code":"Px00030610444","type":"CDM"},{"code":"87107","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.0,"discounted_cash":330.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":161.0,"discounted_cash":56.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MYCOBACTERIA CULTURE - AFB CULTURE","code_information":[{"code":"Px00030610448","type":"CDM"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":1372.0,"discounted_cash":480.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":220.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CULTURE TYPING IMMUNOLOGIC OTH/THN IMMUNOFLUORES LAB","code_information":[{"code":"Px00030610463","type":"CDM"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":86.0,"discounted_cash":30.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":507.0,"discounted_cash":177.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":298.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030610483","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":145.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":311.0,"discounted_cash":108.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MICROBE SUSCEPTIBLE DISK - KIRBY-BAUER","code_information":[{"code":"Px00030610490","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.0,"discounted_cash":273.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":378.0,"discounted_cash":132.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","code_information":[{"code":"Px00030610491","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.0,"discounted_cash":273.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":378.0,"discounted_cash":132.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030610494","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":109.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":75.0,"discounted_cash":26.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030610504","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":1055.0,"discounted_cash":369.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":541.0,"discounted_cash":189.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":277.0,"discounted_cash":96.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1055.0,"discounted_cash":369.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":541.0,"discounted_cash":189.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ LAB","code_information":[{"code":"Px00030610551","type":"CDM"},{"code":"87185","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":37.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SMEAR GRAM STAIN","code_information":[{"code":"Px00030610563","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":145.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":153.0,"discounted_cash":53.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC SMEAR GRAM STAIN - SMEAR FOR EOS","code_information":[{"code":"Px00030610567","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CLOSTRIDIUM AG EIA","code_information":[{"code":"Px00030610581","type":"CDM"},{"code":"87324","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GIARDIA ANTIGEN","code_information":[{"code":"Px00030610583","type":"CDM"},{"code":"87329","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":106.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":220.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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 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"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ","code_information":[{"code":"Px00030610623","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":586.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC URINE-ISO-ID","code_information":[{"code":"Px00030610636","type":"CDM"},{"code":"87088","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":200.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":407.0,"discounted_cash":142.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC FUNGUS CULTURE-HAIR NAIL SKIN","code_information":[{"code":"Px00030610637","type":"CDM"},{"code":"87101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1017.0,"discounted_cash":355.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":157.0,"discounted_cash":54.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC IAAD IA HPYLORI STOOL CDM","code_information":[{"code":"Px00030610663","type":"CDM"},{"code":"87338","type":"HCPCS"}],"standard_charges":[{"gross_charge":1259.0,"discounted_cash":440.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":406.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1394.0,"discounted_cash":487.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC C DIFFICILE ANTIGEN","code_information":[{"code":"Px00030610669","type":"CDM"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":96.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":365.0,"discounted_cash":127.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":144.0,"discounted_cash":50.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":608.0,"discounted_cash":212.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":459.0,"discounted_cash":160.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":608.0,"discounted_cash":212.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":459.0,"discounted_cash":160.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":365.0,"discounted_cash":127.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":144.0,"discounted_cash":50.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC URINALYSIS AUTO W/O SCOPE","code_information":[{"code":"Px00030710008","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":187.0,"discounted_cash":65.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":790.0,"discounted_cash":276.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":597.0,"discounted_cash":208.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC URINALYSIS QUAL/SEMIQUANT EXCEPT IMMUNOASSAYS LAB","code_information":[{"code":"Px00030710026","type":"CDM"},{"code":"81005","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.0,"discounted_cash":261.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":143.0,"discounted_cash":50.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PREGNANCY TEST-URINE (QUAL)","code_information":[{"code":"Px00030710031","type":"CDM"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"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":3212.0,"discounted_cash":1124.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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 NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00031000324","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":73.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":122.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00031000325","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":73.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":122.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PATHOGEN TEST FOR PLATELETS","code_information":[{"code":"Px00031010176","type":"CDM"},{"code":"P9100","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":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":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 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 IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE LAB","code_information":[{"code":"Px00031010386","type":"CDM"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"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"}]},{"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 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 IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE LAB","code_information":[{"code":"Px00031010667","type":"CDM"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"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"}]},{"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":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 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 XR EYE FOR FOREIGN BODY","code_information":[{"code":"Px00032010003","type":"CDM"},{"code":"70030","type":"HCPCS"}],"standard_charges":[{"gross_charge":1402.0,"discounted_cash":490.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":744.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR MANDIBLE 1-3 VIEWS","code_information":[{"code":"Px00032010006","type":"CDM"},{"code":"70100","type":"HCPCS"}],"standard_charges":[{"gross_charge":871.0,"discounted_cash":304.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR MANDIBLE MIN 4 VIEWS","code_information":[{"code":"Px00032010007","type":"CDM"},{"code":"70110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1272.0,"discounted_cash":445.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR MASTOIDS UNI LT/3 VIEWS","code_information":[{"code":"Px00032010008","type":"CDM"},{"code":"70120","type":"HCPCS"}],"standard_charges":[{"gross_charge":934.0,"discounted_cash":326.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR MASTOIDS 3/PLUS VIEWS","code_information":[{"code":"Px00032010009","type":"CDM"},{"code":"70130","type":"HCPCS"}],"standard_charges":[{"gross_charge":1059.0,"discounted_cash":370.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":938.0,"discounted_cash":328.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1336.0,"discounted_cash":467.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1272.0,"discounted_cash":445.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR OPTIC FORAMINA","code_information":[{"code":"Px00032010016","type":"CDM"},{"code":"70190","type":"HCPCS"}],"standard_charges":[{"gross_charge":680.0,"discounted_cash":238.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR ORBITS MIN 4 VIEWS","code_information":[{"code":"Px00032010017","type":"CDM"},{"code":"70200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1355.0,"discounted_cash":474.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":622.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1382.0,"discounted_cash":483.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR SELLA TURCICA","code_information":[{"code":"Px00032010021","type":"CDM"},{"code":"70240","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR SKULL 1-3 VIEWS","code_information":[{"code":"Px00032010022","type":"CDM"},{"code":"70250","type":"HCPCS"}],"standard_charges":[{"gross_charge":884.0,"discounted_cash":309.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR SKULL MIN 4 VIEWS","code_information":[{"code":"Px00032010023","type":"CDM"},{"code":"70260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1181.0,"discounted_cash":413.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR JAW JOINT","code_information":[{"code":"Px00032010027","type":"CDM"},{"code":"70328","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR JAW TEMPOROMANDIBULAR JOINT BIL","code_information":[{"code":"Px00032010028","type":"CDM"},{"code":"70330","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.0,"discounted_cash":342.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN 1 VIEW","code_information":[{"code":"Px00032010029","type":"CDM"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.0,"discounted_cash":304.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR NECK SOFT TISSUE","code_information":[{"code":"Px00032010031","type":"CDM"},{"code":"70360","type":"HCPCS"}],"standard_charges":[{"gross_charge":573.0,"discounted_cash":200.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SPEECH EVALUATION COMPLEX","code_information":[{"code":"Px00032010033","type":"CDM"},{"code":"70371","type":"HCPCS"}],"standard_charges":[{"gross_charge":1171.0,"discounted_cash":409.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR SALIVARY GLAND FOR CALCULUS","code_information":[{"code":"Px00032010035","type":"CDM"},{"code":"70380","type":"HCPCS"}],"standard_charges":[{"gross_charge":897.0,"discounted_cash":313.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR SALIVARY DUCT SIALOGRAPHY","code_information":[{"code":"Px00032010036","type":"CDM"},{"code":"70390","type":"HCPCS"}],"standard_charges":[{"gross_charge":1405.0,"discounted_cash":491.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR BONE LENGTH STUDY","code_information":[{"code":"Px00032010039","type":"CDM"},{"code":"77073","type":"HCPCS"}],"standard_charges":[{"gross_charge":932.0,"discounted_cash":326.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR BONE SURVEY LIMITED","code_information":[{"code":"Px00032010040","type":"CDM"},{"code":"77074","type":"HCPCS"}],"standard_charges":[{"gross_charge":1163.0,"discounted_cash":407.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR ESOPHAGUS W CONTRAST","code_information":[{"code":"Px00032010041","type":"CDM"},{"code":"74220","type":"HCPCS"}],"standard_charges":[{"gross_charge":872.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR RIBS UNI 2 VIEWS","code_information":[{"code":"Px00032010045","type":"CDM"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":982.0,"discounted_cash":343.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1031.0,"discounted_cash":360.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR RIBS BIL 3 VIEWS","code_information":[{"code":"Px00032010048","type":"CDM"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR RIBS/CHEST BILAT","code_information":[{"code":"Px00032010049","type":"CDM"},{"code":"71111","type":"HCPCS"}],"standard_charges":[{"gross_charge":928.0,"discounted_cash":324.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR STERNUM MIN 2 VIEWS","code_information":[{"code":"Px00032010050","type":"CDM"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":301.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":693.0,"discounted_cash":242.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":744.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1031.0,"discounted_cash":360.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1357.0,"discounted_cash":474.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1724.0,"discounted_cash":603.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR SPINE THORACIC 2 VIEWS","code_information":[{"code":"Px00032010059","type":"CDM"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":982.0,"discounted_cash":343.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR SPINE THORACIC 3 VIEWS","code_information":[{"code":"Px00032010060","type":"CDM"},{"code":"72072","type":"HCPCS"}],"standard_charges":[{"gross_charge":1357.0,"discounted_cash":474.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1481.0,"discounted_cash":518.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":982.0,"discounted_cash":343.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":938.0,"discounted_cash":328.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SPINE LUMBOSACRAL MIN 4 VIEWS","code_information":[{"code":"Px00032010066","type":"CDM"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1808.0,"discounted_cash":632.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1808.0,"discounted_cash":632.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":763.0,"discounted_cash":267.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":782.0,"discounted_cash":273.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":833.0,"discounted_cash":291.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1110.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR TAILBONE MIN 2 VIEWS","code_information":[{"code":"Px00032010075","type":"CDM"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":928.0,"discounted_cash":324.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR MYELOGRAPHY CERVICAL","code_information":[{"code":"Px00032010076","type":"CDM"},{"code":"72240","type":"HCPCS"}],"standard_charges":[{"gross_charge":2967.0,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR MYELOGRAPHY THORACIC","code_information":[{"code":"Px00032010077","type":"CDM"},{"code":"72255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2561.0,"discounted_cash":896.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR MYELOGRAPHY LUMBAR","code_information":[{"code":"Px00032010078","type":"CDM"},{"code":"72265","type":"HCPCS"}],"standard_charges":[{"gross_charge":2848.0,"discounted_cash":996.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3558.0,"discounted_cash":1245.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR DISKOGRAPHY CERVICAL/THORACIC","code_information":[{"code":"Px00032010081","type":"CDM"},{"code":"72285","type":"HCPCS"}],"standard_charges":[{"gross_charge":2655.0,"discounted_cash":929.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR DISKOGRAPHY LUMBAR","code_information":[{"code":"Px00032010083","type":"CDM"},{"code":"72295","type":"HCPCS"}],"standard_charges":[{"gross_charge":2655.0,"discounted_cash":929.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR CLAVICLE  COMPLETE","code_information":[{"code":"Px00032010085","type":"CDM"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1601.0,"discounted_cash":560.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR ELBOW LIMITED","code_information":[{"code":"Px00032010086","type":"CDM"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":928.0,"discounted_cash":324.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR HEEL MIN 2 VIEWS","code_information":[{"code":"Px00032010088","type":"CDM"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":278.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR SCAPULA COMPLETE","code_information":[{"code":"Px00032010089","type":"CDM"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":218.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR FOOT MIN 3 VIEWS","code_information":[{"code":"Px00032010091","type":"CDM"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":928.0,"discounted_cash":324.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR SHOULDER 1 VIEW","code_information":[{"code":"Px00032010092","type":"CDM"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":128.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR SHOULDER ARTHROGRAPHY","code_information":[{"code":"Px00032010097","type":"CDM"},{"code":"73040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1531.0,"discounted_cash":535.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR CONTRAST ANKLE","code_information":[{"code":"Px00032010098","type":"CDM"},{"code":"73615","type":"HCPCS"}],"standard_charges":[{"gross_charge":1235.0,"discounted_cash":432.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1244.0,"discounted_cash":435.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR HUMERUS 1 VIEW","code_information":[{"code":"Px00032010101","type":"CDM"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":301.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR HUMERUS MIN 2 VIEWS","code_information":[{"code":"Px00032010102","type":"CDM"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":301.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR ELBOW 2 VIEWS","code_information":[{"code":"Px00032010105","type":"CDM"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":928.0,"discounted_cash":324.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1097.0,"discounted_cash":383.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN 2 VIEWS","code_information":[{"code":"Px00032010107","type":"CDM"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":1034.0,"discounted_cash":361.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR FOOT 2 VIEWS","code_information":[{"code":"Px00032010110","type":"CDM"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":191.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR ARTHROGRAM OF ELBOW","code_information":[{"code":"Px00032010111","type":"CDM"},{"code":"73085","type":"HCPCS"}],"standard_charges":[{"gross_charge":1639.0,"discounted_cash":573.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR FOREARM 2 VIEWS","code_information":[{"code":"Px00032010112","type":"CDM"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":301.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":475.0,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR WRIST 1 VIEW","code_information":[{"code":"Px00032010117","type":"CDM"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.0,"discounted_cash":330.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR WRIST 2 VIEWS","code_information":[{"code":"Px00032010118","type":"CDM"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.0,"discounted_cash":330.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":982.0,"discounted_cash":343.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR WRIST ARTHROGRAPHY","code_information":[{"code":"Px00032010122","type":"CDM"},{"code":"73115","type":"HCPCS"}],"standard_charges":[{"gross_charge":1019.0,"discounted_cash":356.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR HAND 1 VIEW","code_information":[{"code":"Px00032010125","type":"CDM"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1334.0,"discounted_cash":466.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR HAND 2 VIEWS","code_information":[{"code":"Px00032010127","type":"CDM"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1334.0,"discounted_cash":466.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR HAND MIN 3 VIEWS","code_information":[{"code":"Px00032010129","type":"CDM"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":1601.0,"discounted_cash":560.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":744.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN 3/PLUS VIEWS","code_information":[{"code":"Px00032010135","type":"CDM"},{"code":"74021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1202.0,"discounted_cash":420.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR HIP ARTHROGRAPHY","code_information":[{"code":"Px00032010140","type":"CDM"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1221.0,"discounted_cash":427.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR KNEE 1-2 VIEWS","code_information":[{"code":"Px00032010149","type":"CDM"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":191.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR KNEE 3 VIEWS","code_information":[{"code":"Px00032010152","type":"CDM"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":1057.0,"discounted_cash":369.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR KNEE 4/PLUS VIEWS","code_information":[{"code":"Px00032010154","type":"CDM"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":1368.0,"discounted_cash":478.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR KNEES STANDING BILAT","code_information":[{"code":"Px00032010156","type":"CDM"},{"code":"73565","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":191.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR KNEE JOINT W CONTRAST","code_information":[{"code":"Px00032010157","type":"CDM"},{"code":"73580","type":"HCPCS"}],"standard_charges":[{"gross_charge":1678.0,"discounted_cash":587.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR LOWER LEG 2 VIEWS","code_information":[{"code":"Px00032010159","type":"CDM"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":1324.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":475.0,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR ANKLE 2 VIEWS","code_information":[{"code":"Px00032010163","type":"CDM"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":318.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":928.0,"discounted_cash":324.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN COMPLETE SERIES","code_information":[{"code":"Px00032010175","type":"CDM"},{"code":"74022","type":"HCPCS"}],"standard_charges":[{"gross_charge":1582.0,"discounted_cash":553.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2377.0,"discounted_cash":831.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1559.0,"discounted_cash":545.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1635.0,"discounted_cash":572.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR SMALL INTESTINE W CONTRAST","code_information":[{"code":"Px00032010187","type":"CDM"},{"code":"74250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1083.0,"discounted_cash":379.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN PORTABLE 1 VIEW","code_information":[{"code":"Px00032010190","type":"CDM"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.0,"discounted_cash":304.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR COLON W CONTRAST","code_information":[{"code":"Px00032010191","type":"CDM"},{"code":"74270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1290.0,"discounted_cash":451.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR COLON DOUBLE CONTRAST","code_information":[{"code":"Px00032010192","type":"CDM"},{"code":"74280","type":"HCPCS"}],"standard_charges":[{"gross_charge":1989.0,"discounted_cash":696.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":567.0,"discounted_cash":198.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR CONTRAST GALLBLADDER","code_information":[{"code":"Px00032010194","type":"CDM"},{"code":"74290","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":263.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR BILE DUCTS/PANCREAS INTRAOP","code_information":[{"code":"Px00032010196","type":"CDM"},{"code":"74300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1710.0,"discounted_cash":598.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR BILE DUCT ENDOSCOPY","code_information":[{"code":"Px00032010201","type":"CDM"},{"code":"74328","type":"HCPCS"}],"standard_charges":[{"gross_charge":1605.0,"discounted_cash":561.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR BILE/PANC ENDOSCOPY","code_information":[{"code":"Px00032010203","type":"CDM"},{"code":"74330","type":"HCPCS"}],"standard_charges":[{"gross_charge":1719.0,"discounted_cash":601.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR INTRO LONG GI TUBE","code_information":[{"code":"Px00032010204","type":"CDM"},{"code":"74340","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":136.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR GUIDE GI DILATION","code_information":[{"code":"Px00032010206","type":"CDM"},{"code":"74360","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":136.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1362.0,"discounted_cash":476.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2103.0,"discounted_cash":736.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC UROGRAPHY INFUSION W/TOMOGRAPHY","code_information":[{"code":"Px00032010210","type":"CDM"},{"code":"74415","type":"HCPCS"}],"standard_charges":[{"gross_charge":1984.0,"discounted_cash":694.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1583.0,"discounted_cash":554.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR UROGRAPHY ANTEGRADE W CONTRAST","code_information":[{"code":"Px00032010212","type":"CDM"},{"code":"74425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1786.0,"discounted_cash":625.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1037.0,"discounted_cash":362.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1557.0,"discounted_cash":544.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR URETHRA/BLADDER VOIDING","code_information":[{"code":"Px00032010217","type":"CDM"},{"code":"74455","type":"HCPCS"}],"standard_charges":[{"gross_charge":1478.0,"discounted_cash":517.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1980.0,"discounted_cash":693.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC AORTOGRAPHY THORACIC W/O SERIAL","code_information":[{"code":"Px00032010226","type":"CDM"},{"code":"75600","type":"HCPCS"}],"standard_charges":[{"gross_charge":7885.0,"discounted_cash":2759.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":17073.0,"discounted_cash":5975.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10250.0,"discounted_cash":3587.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10250.0,"discounted_cash":3587.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10250.0,"discounted_cash":3587.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11274.0,"discounted_cash":3945.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":17073.0,"discounted_cash":5975.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR ANGIO PELVIC W CONTRAST","code_information":[{"code":"Px00032010247","type":"CDM"},{"code":"75736","type":"HCPCS"}],"standard_charges":[{"gross_charge":17073.0,"discounted_cash":5975.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5178.0,"discounted_cash":1812.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR ARTERY LUNG NON-SELECTIVE","code_information":[{"code":"Px00032010250","type":"CDM"},{"code":"75746","type":"HCPCS"}],"standard_charges":[{"gross_charge":5178.0,"discounted_cash":1812.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR ANGIO MAMMARY INTERNAL","code_information":[{"code":"Px00032010251","type":"CDM"},{"code":"75756","type":"HCPCS"}],"standard_charges":[{"gross_charge":6732.0,"discounted_cash":2356.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR ANGIO EA ADDITIONAL VESSEL","code_information":[{"code":"Px00032010252","type":"CDM"},{"code":"75774","type":"HCPCS"}],"standard_charges":[{"gross_charge":937.0,"discounted_cash":327.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR NONVASCULAR SHUNT","code_information":[{"code":"Px00032010258","type":"CDM"},{"code":"75809","type":"HCPCS"}],"standard_charges":[{"gross_charge":1240.0,"discounted_cash":434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5034.0,"discounted_cash":1761.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5034.0,"discounted_cash":1761.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10250.0,"discounted_cash":3587.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4520.0,"discounted_cash":1582.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":23463.0,"discounted_cash":8212.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7693.0,"discounted_cash":2692.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5387.0,"discounted_cash":1885.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REMOVE CVA LUMEN OBSTRUCT","code_information":[{"code":"Px00032010290","type":"CDM"},{"code":"75902","type":"HCPCS"}],"standard_charges":[{"gross_charge":4137.0,"discounted_cash":1447.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3361.0,"discounted_cash":1176.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1747.0,"discounted_cash":611.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FLUOROSCOPY UP TO 1 HR","code_information":[{"code":"Px00032010318","type":"CDM"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":288.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR FISTULA/SINUS ABSCESS","code_information":[{"code":"Px00032010321","type":"CDM"},{"code":"76080","type":"HCPCS"}],"standard_charges":[{"gross_charge":1113.0,"discounted_cash":389.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR SURGICAL SPECIMEN","code_information":[{"code":"Px00032010322","type":"CDM"},{"code":"76098","type":"HCPCS"}],"standard_charges":[{"gross_charge":2587.0,"discounted_cash":905.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TOMOGRAPHY SINGLE PLANE","code_information":[{"code":"Px00032010323","type":"CDM"},{"code":"76100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":453.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":539.0,"discounted_cash":188.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":539.0,"discounted_cash":188.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FLUOROGUIDE FOR SPINE INJECT","code_information":[{"code":"Px00032010332","type":"CDM"},{"code":"77003","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":483.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR MAMMARY DUCT SINGLE","code_information":[{"code":"Px00032010335","type":"CDM"},{"code":"77053","type":"HCPCS"}],"standard_charges":[{"gross_charge":1017.0,"discounted_cash":355.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR MAMMARY DUCT MULTIPLE","code_information":[{"code":"Px00032010336","type":"CDM"},{"code":"77054","type":"HCPCS"}],"standard_charges":[{"gross_charge":1116.0,"discounted_cash":390.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR BONE AGE STUDY","code_information":[{"code":"Px00032010338","type":"CDM"},{"code":"77072","type":"HCPCS"}],"standard_charges":[{"gross_charge":928.0,"discounted_cash":324.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR BONE SURVEY COMPLETE","code_information":[{"code":"Px00032010341","type":"CDM"},{"code":"77075","type":"HCPCS"}],"standard_charges":[{"gross_charge":2458.0,"discounted_cash":860.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR BONE SURVEY INFANT","code_information":[{"code":"Px00032010342","type":"CDM"},{"code":"77076","type":"HCPCS"}],"standard_charges":[{"gross_charge":897.0,"discounted_cash":313.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR JOINT SURVEY 1 VIEW","code_information":[{"code":"Px00032010343","type":"CDM"},{"code":"77077","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":786.0,"discounted_cash":275.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":489.0,"discounted_cash":171.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":791.0,"discounted_cash":276.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":982.0,"discounted_cash":343.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR FOREARM 1 VIEW","code_information":[{"code":"Px00032010483","type":"CDM"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":301.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PERQ STENT/CHEST VERT ART","code_information":[{"code":"Px00032010495","type":"CDM"},{"code":"0075T","type":"HCPCS"}],"standard_charges":[{"gross_charge":32226.0,"discounted_cash":11279.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR LOWER LEG LIMITED","code_information":[{"code":"Px00032010499","type":"CDM"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":1324.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR ANKLE 1 VIEW","code_information":[{"code":"Px00032010503","type":"CDM"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":318.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR FOOT 1 VIEW","code_information":[{"code":"Px00032010505","type":"CDM"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":191.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC AORTOGRAPHY ABDOMINAL INTRAOPERATIVE","code_information":[{"code":"Px00032010523","type":"CDM"},{"code":"75625","type":"HCPCS"}],"standard_charges":[{"gross_charge":10250.0,"discounted_cash":3587.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR STERNUM 1 VIEW","code_information":[{"code":"Px00032010600","type":"CDM"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":301.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":904.0,"discounted_cash":316.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC VERTEB FRACTURE ASSESSMENT VIA DXA","code_information":[{"code":"Px00032010603","type":"CDM"},{"code":"77086","type":"HCPCS"}],"standard_charges":[{"gross_charge":355.0,"discounted_cash":124.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR ENTIRE SPINE 1 VIEW","code_information":[{"code":"Px00032010604","type":"CDM"},{"code":"72081","type":"HCPCS"}],"standard_charges":[{"gross_charge":619.0,"discounted_cash":216.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":798.0,"discounted_cash":279.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1039.0,"discounted_cash":363.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1379.0,"discounted_cash":482.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":294.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1357.0,"discounted_cash":474.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1492.0,"discounted_cash":522.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1442.0,"discounted_cash":504.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1587.0,"discounted_cash":555.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1744.0,"discounted_cash":610.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR FEMUR 1 VIEW","code_information":[{"code":"Px00032010614","type":"CDM"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.0,"discounted_cash":347.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR FEMUR MIN 2 VIEWS","code_information":[{"code":"Px00032010615","type":"CDM"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1324.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR CHEST 1 VIEW","code_information":[{"code":"Px00032410014","type":"CDM"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.0,"discounted_cash":292.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR CHEST 2 VIEWS","code_information":[{"code":"Px00032410015","type":"CDM"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":1179.0,"discounted_cash":412.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR CHEST 3 VIEWS","code_information":[{"code":"Px00032410016","type":"CDM"},{"code":"71047","type":"HCPCS"}],"standard_charges":[{"gross_charge":1294.0,"discounted_cash":452.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR CHEST 4/PLUS VIEWS","code_information":[{"code":"Px00032410017","type":"CDM"},{"code":"71048","type":"HCPCS"}],"standard_charges":[{"gross_charge":1422.0,"discounted_cash":497.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC XR CHEST PORTABLE 1 VIEW","code_information":[{"code":"Px00032410018","type":"CDM"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.0,"discounted_cash":292.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":221.0,"discounted_cash":77.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":221.0,"discounted_cash":77.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1728.0,"discounted_cash":604.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC THER RAD SIMULATION SIMPLE","code_information":[{"code":"Px00033310006","type":"CDM"},{"code":"77280","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":243.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC THER RAD SIMULATION INTERMEDIATE","code_information":[{"code":"Px00033310007","type":"CDM"},{"code":"77285","type":"HCPCS"}],"standard_charges":[{"gross_charge":1090.0,"discounted_cash":381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC THER RAD SIMULATION COMPLEX","code_information":[{"code":"Px00033310008","type":"CDM"},{"code":"77290","type":"HCPCS"}],"standard_charges":[{"gross_charge":1376.0,"discounted_cash":481.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC THER RAD SIMULATION 3D","code_information":[{"code":"Px00033310009","type":"CDM"},{"code":"77295","type":"HCPCS"}],"standard_charges":[{"gross_charge":3306.0,"discounted_cash":1157.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BASIC DOSIMETRY CALC","code_information":[{"code":"Px00033310010","type":"CDM"},{"code":"77300","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RADIOTHERAPY DOSE PLAN, IMRT","code_information":[{"code":"Px00033310012","type":"CDM"},{"code":"77301","type":"HCPCS"}],"standard_charges":[{"gross_charge":2837.0,"discounted_cash":992.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SPECIAL TELETX PORT PLAN","code_information":[{"code":"Px00033310018","type":"CDM"},{"code":"77321","type":"HCPCS"}],"standard_charges":[{"gross_charge":701.0,"discounted_cash":245.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SPECIAL RADIATION DOSIMETRY","code_information":[{"code":"Px00033310022","type":"CDM"},{"code":"77331","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TREATMENT DEVICES SIMPLE","code_information":[{"code":"Px00033310023","type":"CDM"},{"code":"77332","type":"HCPCS"}],"standard_charges":[{"gross_charge":819.0,"discounted_cash":286.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TREATMENT DEVICES INTERMEDIATE","code_information":[{"code":"Px00033310024","type":"CDM"},{"code":"77333","type":"HCPCS"}],"standard_charges":[{"gross_charge":1369.0,"discounted_cash":479.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TREATMENT DEVICES COMPLEX","code_information":[{"code":"Px00033310025","type":"CDM"},{"code":"77334","type":"HCPCS"}],"standard_charges":[{"gross_charge":1908.0,"discounted_cash":667.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CONTINUING PHYSICS CONSULT","code_information":[{"code":"Px00033310027","type":"CDM"},{"code":"77336","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":135.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DESIGN MLC DEVICE FOR IMRT","code_information":[{"code":"Px00033310028","type":"CDM"},{"code":"77338","type":"HCPCS"}],"standard_charges":[{"gross_charge":6686.0,"discounted_cash":2340.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SPECIAL PHYSICS CONSULT","code_information":[{"code":"Px00033310029","type":"CDM"},{"code":"77370","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":750.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SPECIAL RADIATION TREATMENT","code_information":[{"code":"Px00033310057","type":"CDM"},{"code":"77470","type":"HCPCS"}],"standard_charges":[{"gross_charge":1161.0,"discounted_cash":406.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC APPLY INTERSTITIAL RAD SRC COMPLX","code_information":[{"code":"Px00033310064","type":"CDM"},{"code":"77778","type":"HCPCS"}],"standard_charges":[{"gross_charge":4355.0,"discounted_cash":1524.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC APPLY SURFACE RADIATION","code_information":[{"code":"Px00033310073","type":"CDM"},{"code":"77789","type":"HCPCS"}],"standard_charges":[{"gross_charge":464.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RADIATION HANDLING","code_information":[{"code":"Px00033310074","type":"CDM"},{"code":"77790","type":"HCPCS"}],"standard_charges":[{"gross_charge":1552.0,"discounted_cash":543.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TELETHX ISODOSE PLAN SIMPLE","code_information":[{"code":"Px00033310091","type":"CDM"},{"code":"77306","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TELETHX ISODOSE PLAN COMPLEX","code_information":[{"code":"Px00033310092","type":"CDM"},{"code":"77307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1918.0,"discounted_cash":671.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BRACHYTX ISODOSE PLAN SIMPLE","code_information":[{"code":"Px00033310093","type":"CDM"},{"code":"77316","type":"HCPCS"}],"standard_charges":[{"gross_charge":1597.0,"discounted_cash":558.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BRACHYTX ISODOSE INTERMEDIATE","code_information":[{"code":"Px00033310094","type":"CDM"},{"code":"77317","type":"HCPCS"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BRACHYTX ISODOSE COMPLEX","code_information":[{"code":"Px00033310095","type":"CDM"},{"code":"77318","type":"HCPCS"}],"standard_charges":[{"gross_charge":3156.0,"discounted_cash":1104.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IMRT DELIVERY SIMPLE","code_information":[{"code":"Px00033310096","type":"CDM"},{"code":"77385","type":"HCPCS"}],"standard_charges":[{"gross_charge":1106.0,"discounted_cash":387.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IMRT DELIVERY COMPLEX","code_information":[{"code":"Px00033310097","type":"CDM"},{"code":"77386","type":"HCPCS"}],"standard_charges":[{"gross_charge":1381.0,"discounted_cash":483.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":398.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RAD TX SIMPLE","code_information":[{"code":"Px00033310099","type":"CDM"},{"code":"77402","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":117.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RAD TX INTERMEDIATE","code_information":[{"code":"Px00033310100","type":"CDM"},{"code":"77407","type":"HCPCS"}],"standard_charges":[{"gross_charge":355.0,"discounted_cash":124.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RAD TX COMPLEX","code_information":[{"code":"Px00033310101","type":"CDM"},{"code":"77412","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":142.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CHEMOTHERAPY IV INFUSION CONCURRENT CDM","code_information":[{"code":"Px00033500001","type":"CDM"},{"code":"96549","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":99.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":229.0,"discounted_cash":80.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1728.0,"discounted_cash":604.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":159.0,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":229.0,"discounted_cash":80.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CHEMO ADMIN PERITONEAL CAVITY VIA PORT OR CATH CDM","code_information":[{"code":"Px00033510013","type":"CDM"},{"code":"96446","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.0,"discounted_cash":346.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":742.0,"discounted_cash":259.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM PULM PERFUSION DIFF","code_information":[{"code":"Px00034010009","type":"CDM"},{"code":"78597","type":"HCPCS"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":625.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM HEPATOBILIARY SYSTEM","code_information":[{"code":"Px00034010010","type":"CDM"},{"code":"78226","type":"HCPCS"}],"standard_charges":[{"gross_charge":2685.0,"discounted_cash":939.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC THYROID MET IMAGING WHOLE BODY","code_information":[{"code":"Px00034110007","type":"CDM"},{"code":"78018","type":"HCPCS"}],"standard_charges":[{"gross_charge":1884.0,"discounted_cash":659.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM PARATHYROID","code_information":[{"code":"Px00034110009","type":"CDM"},{"code":"78070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1190.0,"discounted_cash":416.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BONE MARROW IMAGING MULTIPLE","code_information":[{"code":"Px00034110012","type":"CDM"},{"code":"78103","type":"HCPCS"}],"standard_charges":[{"gross_charge":1772.0,"discounted_cash":620.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SPLEEN IMAGING","code_information":[{"code":"Px00034110020","type":"CDM"},{"code":"78185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1220.0,"discounted_cash":427.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM LYMPH SYSTEM","code_information":[{"code":"Px00034110021","type":"CDM"},{"code":"78195","type":"HCPCS"}],"standard_charges":[{"gross_charge":2404.0,"discounted_cash":841.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LIVER IMAGING STATIC","code_information":[{"code":"Px00034110023","type":"CDM"},{"code":"78201","type":"HCPCS"}],"standard_charges":[{"gross_charge":1872.0,"discounted_cash":655.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LIVER IMAGING W/VASCULAR FLOW","code_information":[{"code":"Px00034110024","type":"CDM"},{"code":"78202","type":"HCPCS"}],"standard_charges":[{"gross_charge":2084.0,"discounted_cash":729.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM LIVER SPLEEN STATIC ONLY","code_information":[{"code":"Px00034110027","type":"CDM"},{"code":"78215","type":"HCPCS"}],"standard_charges":[{"gross_charge":1938.0,"discounted_cash":678.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM HEPATOBILIARY SYSTEM W DRUG","code_information":[{"code":"Px00034110030","type":"CDM"},{"code":"78227","type":"HCPCS"}],"standard_charges":[{"gross_charge":2685.0,"discounted_cash":939.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SALIVARY GLAND IMAGING","code_information":[{"code":"Px00034110031","type":"CDM"},{"code":"78230","type":"HCPCS"}],"standard_charges":[{"gross_charge":1352.0,"discounted_cash":473.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGEAL MOTILITY STUDY","code_information":[{"code":"Px00034110034","type":"CDM"},{"code":"78258","type":"HCPCS"}],"standard_charges":[{"gross_charge":1626.0,"discounted_cash":569.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM GASTRIC EMPTYING IMG STDY","code_information":[{"code":"Px00034110037","type":"CDM"},{"code":"78264","type":"HCPCS"}],"standard_charges":[{"gross_charge":2406.0,"discounted_cash":842.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC KIDNEY IMAGING MORPHOLOGY","code_information":[{"code":"Px00034110041","type":"CDM"},{"code":"78700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":636.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM ACUTE GI BLEED STUDY","code_information":[{"code":"Px00034110042","type":"CDM"},{"code":"78278","type":"HCPCS"}],"standard_charges":[{"gross_charge":2008.0,"discounted_cash":702.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM INTESTINE MECKEL VOLVULUS","code_information":[{"code":"Px00034110044","type":"CDM"},{"code":"78290","type":"HCPCS"}],"standard_charges":[{"gross_charge":2008.0,"discounted_cash":702.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM PERITONEAL VENOUS SHUNT PATENCY","code_information":[{"code":"Px00034110045","type":"CDM"},{"code":"78291","type":"HCPCS"}],"standard_charges":[{"gross_charge":1352.0,"discounted_cash":473.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM BONE AND OR JOINT IMAGING LIMITED AREA CDM","code_information":[{"code":"Px00034110047","type":"CDM"},{"code":"78300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1564.0,"discounted_cash":547.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2264.0,"discounted_cash":792.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2422.0,"discounted_cash":847.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM MYCARD PERFUS SPECT SINGLE","code_information":[{"code":"Px00034110055","type":"CDM"},{"code":"78451","type":"HCPCS"}],"standard_charges":[{"gross_charge":3528.0,"discounted_cash":1234.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM MYCARD PERFUS SPECT MULTIPLE","code_information":[{"code":"Px00034110056","type":"CDM"},{"code":"78452","type":"HCPCS"}],"standard_charges":[{"gross_charge":5675.0,"discounted_cash":1986.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM CARDIAC BLOOD POOL SINGLE","code_information":[{"code":"Px00034110064","type":"CDM"},{"code":"78472","type":"HCPCS"}],"standard_charges":[{"gross_charge":3211.0,"discounted_cash":1123.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC HEART IMAGE BLOOD POOL GATED SPECT","code_information":[{"code":"Px00034110068","type":"CDM"},{"code":"78494","type":"HCPCS"}],"standard_charges":[{"gross_charge":1826.0,"discounted_cash":639.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM PULM PERFUSION PARTICULATE","code_information":[{"code":"Px00034110070","type":"CDM"},{"code":"78580","type":"HCPCS"}],"standard_charges":[{"gross_charge":1910.0,"discounted_cash":668.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PULMONARY VENTILATION IMAGING","code_information":[{"code":"Px00034110072","type":"CDM"},{"code":"78579","type":"HCPCS"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":625.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM PULM PERFUSION VENT IMAGING","code_information":[{"code":"Px00034110073","type":"CDM"},{"code":"78582","type":"HCPCS"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":625.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM PULM PERFUSION VENT DIFF","code_information":[{"code":"Px00034110077","type":"CDM"},{"code":"78598","type":"HCPCS"}],"standard_charges":[{"gross_charge":1521.0,"discounted_cash":532.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BRAIN VASCULAR FLOW IMAGING ONLY","code_information":[{"code":"Px00034110084","type":"CDM"},{"code":"78610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":509.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM CSF FLOW CISTERNOGRAM","code_information":[{"code":"Px00034110085","type":"CDM"},{"code":"78630","type":"HCPCS"}],"standard_charges":[{"gross_charge":2931.0,"discounted_cash":1025.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM KIDNEY W VASCULAR FLOW","code_information":[{"code":"Px00034110092","type":"CDM"},{"code":"78701","type":"HCPCS"}],"standard_charges":[{"gross_charge":2025.0,"discounted_cash":708.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3268.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3581.0,"discounted_cash":1253.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC URINARY BLADDER RESIDUAL STUDY","code_information":[{"code":"Px00034110098","type":"CDM"},{"code":"78730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":509.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1591.0,"discounted_cash":556.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM TESTES W VASCULAR FLOW","code_information":[{"code":"Px00034110100","type":"CDM"},{"code":"78761","type":"HCPCS"}],"standard_charges":[{"gross_charge":1560.0,"discounted_cash":546.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1902.0,"discounted_cash":665.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4059.0,"discounted_cash":1420.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5601.0,"discounted_cash":1960.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4538.0,"discounted_cash":1588.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM HEPATOBILIARY SYSTEM W DRUG","code_information":[{"code":"Px00034110132","type":"CDM"},{"code":"78227","type":"HCPCS"}],"standard_charges":[{"gross_charge":2685.0,"discounted_cash":939.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1105.0,"discounted_cash":386.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC THYROID IMAGING WITH VASCULAR FLOW","code_information":[{"code":"Px00034110143","type":"CDM"},{"code":"78013","type":"HCPCS"}],"standard_charges":[{"gross_charge":985.0,"discounted_cash":344.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1342.0,"discounted_cash":469.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3828.0,"discounted_cash":1339.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5805.0,"discounted_cash":2031.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NM GASTRIC EMPTYING SB TRANSIT","code_information":[{"code":"Px00034130006","type":"CDM"},{"code":"78265","type":"HCPCS"}],"standard_charges":[{"gross_charge":2406.0,"discounted_cash":842.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2649.0,"discounted_cash":927.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RADIOPHARM THERAPY, BY ORAL ADMIN","code_information":[{"code":"Px00034210001","type":"CDM"},{"code":"79005","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5654.0,"discounted_cash":1978.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1161.0,"discounted_cash":406.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT MAXILLOFACIAL WO & W CONTRAST","code_information":[{"code":"Px00035010006","type":"CDM"},{"code":"70488","type":"HCPCS"}],"standard_charges":[{"gross_charge":5821.0,"discounted_cash":2037.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1811.0,"discounted_cash":633.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT SOFT TISSUE NECK WO CONTRAST","code_information":[{"code":"Px00035010007","type":"CDM"},{"code":"70490","type":"HCPCS"}],"standard_charges":[{"gross_charge":9169.0,"discounted_cash":3209.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1122.0,"discounted_cash":392.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT SOFT TISSUE NECK W CONTRAST","code_information":[{"code":"Px00035010008","type":"CDM"},{"code":"70491","type":"HCPCS"}],"standard_charges":[{"gross_charge":9295.0,"discounted_cash":3253.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1395.0,"discounted_cash":488.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT SOFT TISSUE NECK W & W/O CONTRAST","code_information":[{"code":"Px00035010009","type":"CDM"},{"code":"70492","type":"HCPCS"}],"standard_charges":[{"gross_charge":9424.0,"discounted_cash":3298.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1757.0,"discounted_cash":614.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT ANGIOGRAPHY NECK W CONTRAST","code_information":[{"code":"Px00035010010","type":"CDM"},{"code":"70498","type":"HCPCS"}],"standard_charges":[{"gross_charge":8824.0,"discounted_cash":3088.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2065.0,"discounted_cash":722.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT THORAX WO CONTRAST","code_information":[{"code":"Px00035010011","type":"CDM"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":4092.0,"discounted_cash":1432.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1174.0,"discounted_cash":410.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT ANGIOGRAPHY CHEST","code_information":[{"code":"Px00035010013","type":"CDM"},{"code":"71275","type":"HCPCS"}],"standard_charges":[{"gross_charge":5025.0,"discounted_cash":1758.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2064.0,"discounted_cash":722.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT LWR EXTREMITY WO & W CONTRAST","code_information":[{"code":"Px00035010018","type":"CDM"},{"code":"73702","type":"HCPCS"}],"standard_charges":[{"gross_charge":4299.0,"discounted_cash":1504.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1874.0,"discounted_cash":655.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT ANGIO LWR EXTR W/O&W/DYE","code_information":[{"code":"Px00035010020","type":"CDM"},{"code":"73706","type":"HCPCS"}],"standard_charges":[{"gross_charge":3542.0,"discounted_cash":1239.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2064.0,"discounted_cash":722.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CTA ABDOMEN W & W/O CONTRAST","code_information":[{"code":"Px00035010023","type":"CDM"},{"code":"74175","type":"HCPCS"}],"standard_charges":[{"gross_charge":4094.0,"discounted_cash":1432.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2064.0,"discounted_cash":722.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT ABD & PELVIS WO CONTRAST","code_information":[{"code":"Px00035010024","type":"CDM"},{"code":"74176","type":"HCPCS"}],"standard_charges":[{"gross_charge":5540.0,"discounted_cash":1939.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2218.0,"discounted_cash":776.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT ABDOMEN & PELVIS W  CONTRAST","code_information":[{"code":"Px00035010025","type":"CDM"},{"code":"74177","type":"HCPCS"}],"standard_charges":[{"gross_charge":6602.0,"discounted_cash":2310.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2955.0,"discounted_cash":1034.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT COLONOGRAPHY SCREENING","code_information":[{"code":"Px00035010026","type":"CDM"},{"code":"74263","type":"HCPCS"}],"standard_charges":[{"gross_charge":2371.0,"discounted_cash":829.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2257.0,"discounted_cash":789.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CCTA HEART W/ CALCIUM SCORING W/O CONTRAST","code_information":[{"code":"Px00035010027","type":"CDM"},{"code":"75571","type":"HCPCS"}],"standard_charges":[{"gross_charge":5040.0,"discounted_cash":1764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":273.0,"discounted_cash":95.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CCTA HEART W/3D IMAGE W/ CONTRAST","code_information":[{"code":"Px00035010028","type":"CDM"},{"code":"75572","type":"HCPCS"}],"standard_charges":[{"gross_charge":5939.0,"discounted_cash":2078.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1078.0,"discounted_cash":377.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CCTA HEART CONGENITAL W/3D IMAGE W/CONTRAST","code_information":[{"code":"Px00035010029","type":"CDM"},{"code":"75573","type":"HCPCS"}],"standard_charges":[{"gross_charge":5939.0,"discounted_cash":2078.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1527.0,"discounted_cash":534.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":6442.0,"discounted_cash":2254.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1631.0,"discounted_cash":570.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CTA AORTA BIL ILIOFEM W & W/O CONTRAST","code_information":[{"code":"Px00035010031","type":"CDM"},{"code":"75635","type":"HCPCS"}],"standard_charges":[{"gross_charge":3910.0,"discounted_cash":1368.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2064.0,"discounted_cash":722.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC 3D RENDER W/O POSTPROCESS","code_information":[{"code":"Px00035010032","type":"CDM"},{"code":"76376","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":373.0,"discounted_cash":130.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC 3D RENDERING W/POSTPROCESS","code_information":[{"code":"Px00035010033","type":"CDM"},{"code":"76377","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":337.0,"discounted_cash":117.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT SCAN FOLLOW-UP STUDY LIMITED","code_information":[{"code":"Px00035010034","type":"CDM"},{"code":"76380","type":"HCPCS"}],"standard_charges":[{"gross_charge":1591.0,"discounted_cash":556.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CT GUIDE PLCMT NEEDLE","code_information":[{"code":"Px00035010037","type":"CDM"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2860.0,"discounted_cash":1001.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":680.0,"discounted_cash":238.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT GUIDE PLCMT RAD FIELD","code_information":[{"code":"Px00035010039","type":"CDM"},{"code":"77014","type":"HCPCS"}],"standard_charges":[{"gross_charge":2860.0,"discounted_cash":1001.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CT COLONOGRAPHY DX","code_information":[{"code":"Px00035010063","type":"CDM"},{"code":"74261","type":"HCPCS"}],"standard_charges":[{"gross_charge":2371.0,"discounted_cash":829.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1183.0,"discounted_cash":414.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CTA ABDOMEN PELVIS","code_information":[{"code":"Px00035010072","type":"CDM"},{"code":"74174","type":"HCPCS"}],"standard_charges":[{"gross_charge":5696.0,"discounted_cash":1993.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3097.0,"discounted_cash":1083.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":1500.0,"discounted_cash":525.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1500.0,"discounted_cash":525.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1500.0,"discounted_cash":525.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CT PERFUSION W/CONTRAST CBF","code_information":[{"code":"Px00035110001","type":"CDM"},{"code":"0042T","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":525.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CT HEAD/BRAIN WO CONTRAST","code_information":[{"code":"Px00035110002","type":"CDM"},{"code":"70450","type":"HCPCS"}],"standard_charges":[{"gross_charge":5286.0,"discounted_cash":1850.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":908.0,"discounted_cash":317.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT HEAD/BRAIN W CONTRAST","code_information":[{"code":"Px00035110007","type":"CDM"},{"code":"70460","type":"HCPCS"}],"standard_charges":[{"gross_charge":5689.0,"discounted_cash":1991.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1174.0,"discounted_cash":410.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT HEAD/BRAIN W & W/O CONTRAST","code_information":[{"code":"Px00035110012","type":"CDM"},{"code":"70470","type":"HCPCS"}],"standard_charges":[{"gross_charge":8330.0,"discounted_cash":2915.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1445.0,"discounted_cash":505.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT ORBIT/EAR/FOSSA WO CONTRAST","code_information":[{"code":"Px00035110014","type":"CDM"},{"code":"70480","type":"HCPCS"}],"standard_charges":[{"gross_charge":5886.0,"discounted_cash":2060.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1183.0,"discounted_cash":414.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT ORBIT/EAR/FOSSA W CONTRAST","code_information":[{"code":"Px00035110017","type":"CDM"},{"code":"70481","type":"HCPCS"}],"standard_charges":[{"gross_charge":6462.0,"discounted_cash":2261.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1695.0,"discounted_cash":593.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT ORBIT/EAR/FOSSA W & W/O CONTRAST","code_information":[{"code":"Px00035110019","type":"CDM"},{"code":"70482","type":"HCPCS"}],"standard_charges":[{"gross_charge":7070.0,"discounted_cash":2474.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1969.0,"discounted_cash":689.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT MAXILLOFACIAL WO CONTRAST","code_information":[{"code":"Px00035110022","type":"CDM"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":5654.0,"discounted_cash":1978.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1183.0,"discounted_cash":414.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT MAXILLOFACIAL W CONTRAST","code_information":[{"code":"Px00035110030","type":"CDM"},{"code":"70487","type":"HCPCS"}],"standard_charges":[{"gross_charge":5736.0,"discounted_cash":2007.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1450.0,"discounted_cash":507.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT ANGIOGRAPHY HEAD W CONTRAST","code_information":[{"code":"Px00035110032","type":"CDM"},{"code":"70496","type":"HCPCS"}],"standard_charges":[{"gross_charge":6266.0,"discounted_cash":2193.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2065.0,"discounted_cash":722.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":3558.0,"discounted_cash":1245.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1174.0,"discounted_cash":410.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT THORAX W CONTRAST","code_information":[{"code":"Px00035210003","type":"CDM"},{"code":"71260","type":"HCPCS"}],"standard_charges":[{"gross_charge":4548.0,"discounted_cash":1591.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1456.0,"discounted_cash":509.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT THORAX W & W/O CONTRAST","code_information":[{"code":"Px00035210006","type":"CDM"},{"code":"71270","type":"HCPCS"}],"standard_charges":[{"gross_charge":5004.0,"discounted_cash":1751.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1837.0,"discounted_cash":642.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT NECK SPINE WO CONTRAST","code_information":[{"code":"Px00035210008","type":"CDM"},{"code":"72125","type":"HCPCS"}],"standard_charges":[{"gross_charge":8824.0,"discounted_cash":3088.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1178.0,"discounted_cash":412.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT NECK SPINE W/DYE","code_information":[{"code":"Px00035210009","type":"CDM"},{"code":"72126","type":"HCPCS"}],"standard_charges":[{"gross_charge":9335.0,"discounted_cash":3267.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1459.0,"discounted_cash":510.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT NECK SPINE W & W/O CONTRAST","code_information":[{"code":"Px00035210010","type":"CDM"},{"code":"72127","type":"HCPCS"}],"standard_charges":[{"gross_charge":9570.0,"discounted_cash":3349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1835.0,"discounted_cash":642.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT CHEST SPINE WO CONTRAST","code_information":[{"code":"Px00035210011","type":"CDM"},{"code":"72128","type":"HCPCS"}],"standard_charges":[{"gross_charge":4016.0,"discounted_cash":1405.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1176.0,"discounted_cash":411.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT CHEST SPINE W CONTRAST","code_information":[{"code":"Px00035210012","type":"CDM"},{"code":"72129","type":"HCPCS"}],"standard_charges":[{"gross_charge":4172.0,"discounted_cash":1460.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1459.0,"discounted_cash":510.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT CHEST SPINE W & W/O CONTRAST","code_information":[{"code":"Px00035210013","type":"CDM"},{"code":"72130","type":"HCPCS"}],"standard_charges":[{"gross_charge":4276.0,"discounted_cash":1496.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1841.0,"discounted_cash":644.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT LUMBAR SPINE WO CONTRAST","code_information":[{"code":"Px00035210014","type":"CDM"},{"code":"72131","type":"HCPCS"}],"standard_charges":[{"gross_charge":3711.0,"discounted_cash":1298.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1174.0,"discounted_cash":410.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT LUMBAR SPINE W CONTRAST","code_information":[{"code":"Px00035210015","type":"CDM"},{"code":"72132","type":"HCPCS"}],"standard_charges":[{"gross_charge":4016.0,"discounted_cash":1405.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1456.0,"discounted_cash":509.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT LUMBAR SPINE W & W/O CONTRAST","code_information":[{"code":"Px00035210016","type":"CDM"},{"code":"72133","type":"HCPCS"}],"standard_charges":[{"gross_charge":4115.0,"discounted_cash":1440.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1837.0,"discounted_cash":642.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CTA PELVIS W & W/O CONTRAST","code_information":[{"code":"Px00035210017","type":"CDM"},{"code":"72191","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":1122.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2064.0,"discounted_cash":722.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT PELVIS WO CONTRAST","code_information":[{"code":"Px00035210018","type":"CDM"},{"code":"72192","type":"HCPCS"}],"standard_charges":[{"gross_charge":2331.0,"discounted_cash":815.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1113.0,"discounted_cash":389.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT PELVIS W CONTRAST","code_information":[{"code":"Px00035210020","type":"CDM"},{"code":"72193","type":"HCPCS"}],"standard_charges":[{"gross_charge":2914.0,"discounted_cash":1019.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1382.0,"discounted_cash":483.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT PELVIS W & W/O CONTRAST","code_information":[{"code":"Px00035210024","type":"CDM"},{"code":"72194","type":"HCPCS"}],"standard_charges":[{"gross_charge":3208.0,"discounted_cash":1122.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1846.0,"discounted_cash":646.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT UPPER EXTREMITY WO CONTRAST","code_information":[{"code":"Px00035210029","type":"CDM"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3306.0,"discounted_cash":1157.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1131.0,"discounted_cash":395.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT LOWER EXTREMITY WO CONTRAST","code_information":[{"code":"Px00035210030","type":"CDM"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":3306.0,"discounted_cash":1157.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1133.0,"discounted_cash":396.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT UPPER EXTREMITY W CONTRAST","code_information":[{"code":"Px00035210031","type":"CDM"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":3802.0,"discounted_cash":1330.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1399.0,"discounted_cash":489.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT UPPR EXTREMITY W & W/O CONTRAST","code_information":[{"code":"Px00035210034","type":"CDM"},{"code":"73202","type":"HCPCS"}],"standard_charges":[{"gross_charge":4299.0,"discounted_cash":1504.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1870.0,"discounted_cash":654.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT ANGIO UPR EXTRM W & W/O CONTRAST","code_information":[{"code":"Px00035210037","type":"CDM"},{"code":"73206","type":"HCPCS"}],"standard_charges":[{"gross_charge":3542.0,"discounted_cash":1239.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2065.0,"discounted_cash":722.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT ABDOMEN WO CONTRAST","code_information":[{"code":"Px00035210038","type":"CDM"},{"code":"74150","type":"HCPCS"}],"standard_charges":[{"gross_charge":3210.0,"discounted_cash":1123.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1104.0,"discounted_cash":386.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT LOWER EXTREMITY W CONTRAST","code_information":[{"code":"Px00035210040","type":"CDM"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":3802.0,"discounted_cash":1330.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1410.0,"discounted_cash":493.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT ABDOMEN W CONTRAST","code_information":[{"code":"Px00035210046","type":"CDM"},{"code":"74160","type":"HCPCS"}],"standard_charges":[{"gross_charge":3690.0,"discounted_cash":1291.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1573.0,"discounted_cash":550.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT ABDOMEN W & W/O CONTRAST","code_information":[{"code":"Px00035210047","type":"CDM"},{"code":"74170","type":"HCPCS"}],"standard_charges":[{"gross_charge":3959.0,"discounted_cash":1385.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2021.0,"discounted_cash":707.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT ABDOMEN & PELVIS W & W/O CONTRAST","code_information":[{"code":"Px00035210054","type":"CDM"},{"code":"74178","type":"HCPCS"}],"standard_charges":[{"gross_charge":7165.0,"discounted_cash":2507.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3867.0,"discounted_cash":1353.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC CT COLONOGRAPHY DX W/DYE","code_information":[{"code":"Px00035210059","type":"CDM"},{"code":"74262","type":"HCPCS"}],"standard_charges":[{"gross_charge":3768.0,"discounted_cash":1318.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1800.0,"discounted_cash":630.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":4092.0,"discounted_cash":1432.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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: JV CPCT LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 2 CDM","code_information":[{"code":"Px00036000022","type":"CDM"}],"standard_charges":[{"gross_charge":4868.0,"discounted_cash":1703.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 3 CDM","code_information":[{"code":"Px00036000023","type":"CDM"}],"standard_charges":[{"gross_charge":9201.0,"discounted_cash":3220.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 4 CDM","code_information":[{"code":"Px00036000024","type":"CDM"}],"standard_charges":[{"gross_charge":11360.0,"discounted_cash":3976.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 5 CDM","code_information":[{"code":"Px00036000025","type":"CDM"}],"standard_charges":[{"gross_charge":15781.0,"discounted_cash":5523.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 6 CDM","code_information":[{"code":"Px00036000026","type":"CDM"}],"standard_charges":[{"gross_charge":19488.0,"discounted_cash":6820.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 1","code_information":[{"code":"Px00036010001","type":"CDM"}],"standard_charges":[{"gross_charge":2093.0,"discounted_cash":732.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 2","code_information":[{"code":"Px00036010002","type":"CDM"}],"standard_charges":[{"gross_charge":3708.0,"discounted_cash":1297.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 3","code_information":[{"code":"Px00036010003","type":"CDM"}],"standard_charges":[{"gross_charge":4772.0,"discounted_cash":1670.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 4","code_information":[{"code":"Px00036010004","type":"CDM"}],"standard_charges":[{"gross_charge":6485.0,"discounted_cash":2269.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 5","code_information":[{"code":"Px00036010005","type":"CDM"}],"standard_charges":[{"gross_charge":10340.0,"discounted_cash":3619.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":30268.0,"discounted_cash":10593.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REMOVE URETER STENT PERCUT","code_information":[{"code":"Px00036010062","type":"CDM"},{"code":"50384","type":"HCPCS"}],"standard_charges":[{"gross_charge":4395.0,"discounted_cash":1538.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REMOVE RENAL TUBE W/FLUORO","code_information":[{"code":"Px00036010064","type":"CDM"},{"code":"50389","type":"HCPCS"}],"standard_charges":[{"gross_charge":10130.0,"discounted_cash":3545.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INJ FORAMEN EPIDURAL C/T","code_information":[{"code":"Px00036010069","type":"CDM"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":5860.0,"discounted_cash":2051.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INJ FORAMEN EPIDURAL L/S","code_information":[{"code":"Px00036010071","type":"CDM"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":5436.0,"discounted_cash":1902.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2175.0,"discounted_cash":761.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5288.0,"discounted_cash":1850.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DX BRONCHOSCOPE/LAVAGE","code_information":[{"code":"Px00036010079","type":"CDM"},{"code":"31624","type":"HCPCS"}],"standard_charges":[{"gross_charge":3718.0,"discounted_cash":1301.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NEEDLE BIOPSY OF LIVER","code_information":[{"code":"Px00036010104","type":"CDM"},{"code":"47000","type":"HCPCS"}],"standard_charges":[{"gross_charge":3860.0,"discounted_cash":1351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PLACE DUOD/JEJ TUBE PERC","code_information":[{"code":"Px00036010105","type":"CDM"},{"code":"49441","type":"HCPCS"}],"standard_charges":[{"gross_charge":11227.0,"discounted_cash":3929.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IDENTIFY SENTINEL NODE","code_information":[{"code":"Px00036010107","type":"CDM"},{"code":"38792","type":"HCPCS"}],"standard_charges":[{"gross_charge":1350.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DRAINAGE OF BREAST LESION","code_information":[{"code":"Px00036010111","type":"CDM"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DRAIN BREAST LESION ADD-ON","code_information":[{"code":"Px00036010112","type":"CDM"},{"code":"19001","type":"HCPCS"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DEEP MUSCLE BIOPSY","code_information":[{"code":"Px00036010122","type":"CDM"},{"code":"20205","type":"HCPCS"}],"standard_charges":[{"gross_charge":6503.0,"discounted_cash":2276.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NEEDLE BX MUSCLE","code_information":[{"code":"Px00036010123","type":"CDM"},{"code":"20206","type":"HCPCS"}],"standard_charges":[{"gross_charge":3860.0,"discounted_cash":1351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BIOPSY VERTEBRA CERV OR LUMBAR CT","code_information":[{"code":"Px00036010125","type":"CDM"},{"code":"20225","type":"HCPCS"}],"standard_charges":[{"gross_charge":7399.0,"discounted_cash":2589.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":377.0,"discounted_cash":131.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":489.0,"discounted_cash":171.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":560.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ASPIRATE/INJ GANGLION CYST","code_information":[{"code":"Px00036010132","type":"CDM"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":974.0,"discounted_cash":340.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR SHOULDER X-RAY","code_information":[{"code":"Px00036010133","type":"CDM"},{"code":"23350","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 1 1ST 30 MINS","code_information":[{"code":"Px00036010146","type":"CDM"}],"standard_charges":[{"gross_charge":8545.0,"discounted_cash":2990.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 2 1ST 30 MINS","code_information":[{"code":"Px00036010147","type":"CDM"}],"standard_charges":[{"gross_charge":9685.0,"discounted_cash":3389.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 3 1ST 30 MINS","code_information":[{"code":"Px00036010148","type":"CDM"}],"standard_charges":[{"gross_charge":10538.0,"discounted_cash":3688.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 4 1ST 30 MINS","code_information":[{"code":"Px00036010149","type":"CDM"}],"standard_charges":[{"gross_charge":19938.0,"discounted_cash":6978.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 5 1ST 30 MINS","code_information":[{"code":"Px00036010150","type":"CDM"}],"standard_charges":[{"gross_charge":22787.0,"discounted_cash":7975.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 6 1ST 30 MINS","code_information":[{"code":"Px00036010151","type":"CDM"}],"standard_charges":[{"gross_charge":25635.0,"discounted_cash":8972.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 7 1ST 30 MINS","code_information":[{"code":"Px00036010152","type":"CDM"}],"standard_charges":[{"gross_charge":27486.0,"discounted_cash":9620.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 8 1ST 30 MINS","code_information":[{"code":"Px00036010153","type":"CDM"}],"standard_charges":[{"gross_charge":30192.0,"discounted_cash":10567.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":14818.0,"discounted_cash":5186.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5834.0,"discounted_cash":2041.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":13612.0,"discounted_cash":4764.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5834.0,"discounted_cash":2041.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC VASC EMBOLIZE/OCCLUDE VENOUS","code_information":[{"code":"Px00036010192","type":"CDM"},{"code":"37241","type":"HCPCS"}],"standard_charges":[{"gross_charge":36594.0,"discounted_cash":12807.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC VASC EMBOLIZE/OCCLUDE ARTERY","code_information":[{"code":"Px00036010193","type":"CDM"},{"code":"37242","type":"HCPCS"}],"standard_charges":[{"gross_charge":37945.0,"discounted_cash":13280.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC VASC EMBOLIZE/OCCLUDE ORGAN","code_information":[{"code":"Px00036010194","type":"CDM"},{"code":"37243","type":"HCPCS"}],"standard_charges":[{"gross_charge":36594.0,"discounted_cash":12807.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC VASC EMBOLIZE/OCCLUDE BLEED","code_information":[{"code":"Px00036010195","type":"CDM"},{"code":"37244","type":"HCPCS"}],"standard_charges":[{"gross_charge":36594.0,"discounted_cash":12807.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PERC FLUID COLLECT VISCERA","code_information":[{"code":"Px00036010196","type":"CDM"},{"code":"49405","type":"HCPCS"}],"standard_charges":[{"gross_charge":17172.0,"discounted_cash":6010.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PERC FLUID COLLECT PERI/RETRO","code_information":[{"code":"Px00036010197","type":"CDM"},{"code":"49406","type":"HCPCS"}],"standard_charges":[{"gross_charge":17172.0,"discounted_cash":6010.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":17172.0,"discounted_cash":6010.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 1 PER MIN","code_information":[{"code":"Px00036010212","type":"CDM"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":24.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 2 PER MIN","code_information":[{"code":"Px00036010214","type":"CDM"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 3 PER MIN","code_information":[{"code":"Px00036010216","type":"CDM"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":35.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 4 PER MIN","code_information":[{"code":"Px00036010218","type":"CDM"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":85.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 5 PER MIN","code_information":[{"code":"Px00036010220","type":"CDM"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":114.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 6 PER MIN","code_information":[{"code":"Px00036010222","type":"CDM"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":132.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 7 PER MIN","code_information":[{"code":"Px00036010224","type":"CDM"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":155.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR SALIVARY X-RAY","code_information":[{"code":"Px00036010324","type":"CDM"},{"code":"42550","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":73.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BIOPSY OF SALIVARY GLAND, NEEDLE","code_information":[{"code":"Px00036010331","type":"CDM"},{"code":"42400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1654.0,"discounted_cash":578.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATHETER FOR HYSTEROGRAPHY","code_information":[{"code":"Px00036010345","type":"CDM"},{"code":"58340","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":96.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BIOPSY OF THYROID","code_information":[{"code":"Px00036010349","type":"CDM"},{"code":"60100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1654.0,"discounted_cash":578.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 6","code_information":[{"code":"Px00036010371","type":"CDM"}],"standard_charges":[{"gross_charge":11012.0,"discounted_cash":3854.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Base Price)"}]},{"description":"HC TRANSCATH RETRIEVAL FB COMPL","code_information":[{"code":"Px00036010378","type":"CDM"},{"code":"37197","type":"HCPCS"}],"standard_charges":[{"gross_charge":21081.0,"discounted_cash":7378.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BONE MARROW BIOPSY","code_information":[{"code":"Px00036010406","type":"CDM"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":2793.0,"discounted_cash":977.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX CDM","code_information":[{"code":"Px00036010408","type":"CDM"},{"code":"31622","type":"HCPCS"}],"standard_charges":[{"gross_charge":3718.0,"discounted_cash":1301.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY DIAGNOSTIC","code_information":[{"code":"Px00036010413","type":"CDM"}],"standard_charges":[{"gross_charge":4248.0,"discounted_cash":1486.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EUS W/ COLONOSCOPY","code_information":[{"code":"Px00036010441","type":"CDM"}],"standard_charges":[{"gross_charge":7568.0,"discounted_cash":2648.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EUS W/ SIGMOIDOSCOPY","code_information":[{"code":"Px00036010442","type":"CDM"}],"standard_charges":[{"gross_charge":7568.0,"discounted_cash":2648.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":8991.0,"discounted_cash":3146.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TIS TRNFR ANY 30.1-60 SQ CM","code_information":[{"code":"Px00036010550","type":"CDM"},{"code":"14301","type":"HCPCS"}],"standard_charges":[{"gross_charge":13731.0,"discounted_cash":4805.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC AMNIOCENTESIS DIAGNOSTIC CDM","code_information":[{"code":"Px00036010901","type":"CDM"},{"code":"59000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1149.0,"discounted_cash":402.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9181.0,"discounted_cash":3213.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC C-SECTION","code_information":[{"code":"Px00036010960","type":"CDM"}],"standard_charges":[{"gross_charge":9372.0,"discounted_cash":3280.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2360.0,"discounted_cash":826.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC C-SECTION MULTI","code_information":[{"code":"Px00036010966","type":"CDM"}],"standard_charges":[{"gross_charge":11715.0,"discounted_cash":4100.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CYSTOSCOPY & URETER CATHETER","code_information":[{"code":"Px00036010984","type":"CDM"},{"code":"52005","type":"HCPCS"}],"standard_charges":[{"gross_charge":5785.0,"discounted_cash":2024.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR ELBOW X-RAY","code_information":[{"code":"Px00036011001","type":"CDM"},{"code":"24220","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC HIP ARTHROGRAM PROC","code_information":[{"code":"Px00036011002","type":"CDM"},{"code":"27093","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ADJ TISS XFER TRUNK 10.1-30","code_information":[{"code":"Px00036011031","type":"CDM"},{"code":"14001","type":"HCPCS"}],"standard_charges":[{"gross_charge":9008.0,"discounted_cash":3152.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EXC THIGH/KNEE LES SC 3 CM/>","code_information":[{"code":"Px00036011078","type":"CDM"},{"code":"27337","type":"HCPCS"}],"standard_charges":[{"gross_charge":12466.0,"discounted_cash":4363.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REMOVAL SWEAT GLAND SIMPLE","code_information":[{"code":"Px00036011175","type":"CDM"},{"code":"11462","type":"HCPCS"}],"standard_charges":[{"gross_charge":4442.0,"discounted_cash":1554.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SKIN FULL GRAFT SCLP/ARM/LEG","code_information":[{"code":"Px00036011209","type":"CDM"},{"code":"15220","type":"HCPCS"}],"standard_charges":[{"gross_charge":7311.0,"discounted_cash":2558.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4698.0,"discounted_cash":1644.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":15172.0,"discounted_cash":5310.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":16884.0,"discounted_cash":5909.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":20269.0,"discounted_cash":7094.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":24121.0,"discounted_cash":8442.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":14298.0,"discounted_cash":5004.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":23938.0,"discounted_cash":8378.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":18406.0,"discounted_cash":6442.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":21102.0,"discounted_cash":7385.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":28209.0,"discounted_cash":9873.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10250.0,"discounted_cash":3587.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":8374.0,"discounted_cash":2930.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11414.0,"discounted_cash":3994.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":8374.0,"discounted_cash":2930.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REPOSITION IVC FILTER COMP","code_information":[{"code":"Px00036012014","type":"CDM"},{"code":"37192","type":"HCPCS"}],"standard_charges":[{"gross_charge":4301.0,"discounted_cash":1505.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EXCISION LINGUAL FRENUM FRENECTOMY CDM","code_information":[{"code":"Px00036100000","type":"CDM"},{"code":"41115","type":"HCPCS"}],"standard_charges":[{"gross_charge":6587.0,"discounted_cash":2305.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4248.0,"discounted_cash":1486.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC I&D SHOULDER DEEP ABSCESS/HEMATOMA","code_information":[{"code":"Px00036100061","type":"CDM"},{"code":"23030","type":"HCPCS"}],"standard_charges":[{"gross_charge":5805.0,"discounted_cash":2031.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EPIDRM AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD","code_information":[{"code":"Px00036100064","type":"CDM"},{"code":"15110","type":"HCPCS"}],"standard_charges":[{"gross_charge":6646.0,"discounted_cash":2326.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/OR LESS","code_information":[{"code":"Px00036100065","type":"CDM"},{"code":"15115","type":"HCPCS"}],"standard_charges":[{"gross_charge":6646.0,"discounted_cash":2326.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2394.0,"discounted_cash":837.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2394.0,"discounted_cash":837.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4002.0,"discounted_cash":1400.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PARTIAL EXCISION BONE PHALANX TOE","code_information":[{"code":"Px00036100105","type":"CDM"},{"code":"28124","type":"HCPCS"}],"standard_charges":[{"gross_charge":11196.0,"discounted_cash":3918.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED CDM","code_information":[{"code":"Px00036100106","type":"CDM"},{"code":"55000","type":"HCPCS"}],"standard_charges":[{"gross_charge":3129.0,"discounted_cash":1095.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OSTECTOMY COMPLETE 1ST METATARSAL HEAD","code_information":[{"code":"Px00036100118","type":"CDM"},{"code":"28111","type":"HCPCS"}],"standard_charges":[{"gross_charge":7606.0,"discounted_cash":2662.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4","code_information":[{"code":"Px00036100119","type":"CDM"},{"code":"28112","type":"HCPCS"}],"standard_charges":[{"gross_charge":7606.0,"discounted_cash":2662.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OSTECTOMY COMPLETE 5TH METATARSAL HEAD","code_information":[{"code":"Px00036100120","type":"CDM"},{"code":"28113","type":"HCPCS"}],"standard_charges":[{"gross_charge":7606.0,"discounted_cash":2662.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OSTECTOMY CALCANEUS","code_information":[{"code":"Px00036100121","type":"CDM"},{"code":"28118","type":"HCPCS"}],"standard_charges":[{"gross_charge":7606.0,"discounted_cash":2662.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OSTECTOMY CALCANEUS SPUR W/WO PLNTAR FASCIAL RLS","code_information":[{"code":"Px00036100122","type":"CDM"},{"code":"28119","type":"HCPCS"}],"standard_charges":[{"gross_charge":14555.0,"discounted_cash":5094.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PARTIAL EXCISION BONE TALUS/CALCANEUS","code_information":[{"code":"Px00036100123","type":"CDM"},{"code":"28120","type":"HCPCS"}],"standard_charges":[{"gross_charge":7606.0,"discounted_cash":2662.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS","code_information":[{"code":"Px00036100124","type":"CDM"},{"code":"28122","type":"HCPCS"}],"standard_charges":[{"gross_charge":7606.0,"discounted_cash":2662.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC I&D ABSCESS PERITONSILLAR CDM","code_information":[{"code":"Px00036100140","type":"CDM"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM CDM","code_information":[{"code":"Px00036100145","type":"CDM"},{"code":"12006","type":"HCPCS"}],"standard_charges":[{"gross_charge":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PARTIAL EXCISION BONE TIBIA CDM","code_information":[{"code":"Px00036100146","type":"CDM"},{"code":"27640","type":"HCPCS"}],"standard_charges":[{"gross_charge":7606.0,"discounted_cash":2662.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BURR HOLE W/EVAC&/DRG HEMATOMA XDRL/SDR","code_information":[{"code":"Px00036100148","type":"CDM"},{"code":"61154","type":"HCPCS"}],"standard_charges":[{"gross_charge":6785.0,"discounted_cash":2374.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF","code_information":[{"code":"Px00036100155","type":"CDM"},{"code":"36833","type":"HCPCS"}],"standard_charges":[{"gross_charge":17444.0,"discounted_cash":6105.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TWIST DRILL HOLE EVAC&/DRG SUBDURAL HEMATOMA CDM","code_information":[{"code":"Px00036100162","type":"CDM"},{"code":"61108","type":"HCPCS"}],"standard_charges":[{"gross_charge":7734.0,"discounted_cash":2706.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM","code_information":[{"code":"Px00036100165","type":"CDM"},{"code":"14302","type":"HCPCS"}],"standard_charges":[{"gross_charge":3918.0,"discounted_cash":1371.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION CDM","code_information":[{"code":"Px00036100174","type":"CDM"},{"code":"27301","type":"HCPCS"}],"standard_charges":[{"gross_charge":12426.0,"discounted_cash":4349.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE","code_information":[{"code":"Px00036100261","type":"CDM"},{"code":"16030","type":"HCPCS"}],"standard_charges":[{"gross_charge":1776.0,"discounted_cash":621.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10298.0,"discounted_cash":3604.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5149.0,"discounted_cash":1802.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10298.0,"discounted_cash":3604.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5149.0,"discounted_cash":1802.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":15829.0,"discounted_cash":5540.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7915.0,"discounted_cash":2770.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":15829.0,"discounted_cash":5540.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7915.0,"discounted_cash":2770.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":37945.0,"discounted_cash":13280.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10298.0,"discounted_cash":3604.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5149.0,"discounted_cash":1802.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10298.0,"discounted_cash":3604.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5149.0,"discounted_cash":1802.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":15829.0,"discounted_cash":5540.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7915.0,"discounted_cash":2770.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":15829.0,"discounted_cash":5540.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7915.0,"discounted_cash":2770.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":13062.0,"discounted_cash":4571.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6531.0,"discounted_cash":2285.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":13062.0,"discounted_cash":4571.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6531.0,"discounted_cash":2285.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":21365.0,"discounted_cash":7477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10683.0,"discounted_cash":3739.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":21365.0,"discounted_cash":7477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10683.0,"discounted_cash":3739.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":13612.0,"discounted_cash":4764.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":20825.0,"discounted_cash":7288.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10413.0,"discounted_cash":3644.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":20825.0,"discounted_cash":7288.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10413.0,"discounted_cash":3644.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":32790.0,"discounted_cash":11476.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":16395.0,"discounted_cash":5738.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":32790.0,"discounted_cash":11476.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":16395.0,"discounted_cash":5738.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":32790.0,"discounted_cash":11476.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":16395.0,"discounted_cash":5738.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":32790.0,"discounted_cash":11476.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":16395.0,"discounted_cash":5738.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":48989.0,"discounted_cash":17146.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":16395.0,"discounted_cash":5738.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":48989.0,"discounted_cash":17146.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":16395.0,"discounted_cash":5738.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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: JV CPCT 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: JV CPCT 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: JV CPCT 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":19748.0,"discounted_cash":6911.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":891.0,"discounted_cash":311.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5585.0,"discounted_cash":1954.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SEL CATH PLCM 3RD ORD","code_information":[{"code":"Px00036110037","type":"CDM"},{"code":"36217","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NASAL/OROGASTRIC W/TUBE PLMT","code_information":[{"code":"Px00036110042","type":"CDM"},{"code":"43752","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.0,"discounted_cash":190.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE","code_information":[{"code":"Px00036110071","type":"CDM"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INJECT EPIDURAL PATCH","code_information":[{"code":"Px00036110072","type":"CDM"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":3024.0,"discounted_cash":1058.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FRENOTOMY LINGUAL CDM","code_information":[{"code":"Px00036110073","type":"CDM"},{"code":"41010","type":"HCPCS"}],"standard_charges":[{"gross_charge":2695.0,"discounted_cash":943.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TRACHEOSTOMY TUBE CHANGE","code_information":[{"code":"Px00036110092","type":"CDM"},{"code":"31502","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BONE MARROW ASPIRATION","code_information":[{"code":"Px00036110101","type":"CDM"},{"code":"38220","type":"HCPCS"}],"standard_charges":[{"gross_charge":2793.0,"discounted_cash":977.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REPOSITION GASTROSTOMY TUBE","code_information":[{"code":"Px00036110104","type":"CDM"},{"code":"43761","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.0,"discounted_cash":340.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTRO GASTROINTESTINAL TUBE","code_information":[{"code":"Px00036110105","type":"CDM"},{"code":"44500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2220.0,"discounted_cash":777.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":365.0,"discounted_cash":127.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INJECTION ABDOMINAL SHUNT","code_information":[{"code":"Px00036110111","type":"CDM"},{"code":"49427","type":"HCPCS"}],"standard_charges":[{"gross_charge":2184.0,"discounted_cash":764.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PLACE GASTROSTOMY TUBE PERC","code_information":[{"code":"Px00036110112","type":"CDM"},{"code":"49440","type":"HCPCS"}],"standard_charges":[{"gross_charge":6437.0,"discounted_cash":2252.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11946.0,"discounted_cash":4181.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REPLACE G/C TUBE PERC","code_information":[{"code":"Px00036110114","type":"CDM"},{"code":"49450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2220.0,"discounted_cash":777.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REPLACE DUOD/JEJ TUBE PERC","code_information":[{"code":"Px00036110115","type":"CDM"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":2220.0,"discounted_cash":777.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS","code_information":[{"code":"Px00036110116","type":"CDM"},{"code":"49452","type":"HCPCS"}],"standard_charges":[{"gross_charge":5414.0,"discounted_cash":1894.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":801.0,"discounted_cash":280.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR URETER X-RAY","code_information":[{"code":"Px00036110121","type":"CDM"},{"code":"50690","type":"HCPCS"}],"standard_charges":[{"gross_charge":1373.0,"discounted_cash":480.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR BLADDER X-RAY","code_information":[{"code":"Px00036110122","type":"CDM"},{"code":"51600","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":370.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR MYELOGRAM","code_information":[{"code":"Px00036110126","type":"CDM"},{"code":"62284","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.0,"discounted_cash":265.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1224.0,"discounted_cash":428.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1224.0,"discounted_cash":428.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2546.0,"discounted_cash":891.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TRLUML PERIP ATHRC ILIAC ART","code_information":[{"code":"Px00036110142","type":"CDM"},{"code":"0238T","type":"HCPCS"}],"standard_charges":[{"gross_charge":21900.0,"discounted_cash":7665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INSERT PLEURAL CATH","code_information":[{"code":"Px00036110166","type":"CDM"},{"code":"32550","type":"HCPCS"}],"standard_charges":[{"gross_charge":13896.0,"discounted_cash":4863.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LYSE CHEST FIBRIN INIT DAY","code_information":[{"code":"Px00036110167","type":"CDM"},{"code":"32561","type":"HCPCS"}],"standard_charges":[{"gross_charge":1165.0,"discounted_cash":407.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LYSE CHEST FIBRIN SUBQ DAY","code_information":[{"code":"Px00036110168","type":"CDM"},{"code":"32562","type":"HCPCS"}],"standard_charges":[{"gross_charge":896.0,"discounted_cash":313.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INSERTION OF HEART PACEMAKER","code_information":[{"code":"Px00036110169","type":"CDM"},{"code":"33206","type":"HCPCS"}],"standard_charges":[{"gross_charge":8861.0,"discounted_cash":3101.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INSERTION PERM HEART PACEMAKER","code_information":[{"code":"Px00036110170","type":"CDM"},{"code":"33207","type":"HCPCS"}],"standard_charges":[{"gross_charge":10160.0,"discounted_cash":3556.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INSERTION PERM AV PACER","code_information":[{"code":"Px00036110171","type":"CDM"},{"code":"33208","type":"HCPCS"}],"standard_charges":[{"gross_charge":13544.0,"discounted_cash":4740.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INSERTION OF HEART ELECTRODE 33210","code_information":[{"code":"Px00036110172","type":"CDM"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":22350.0,"discounted_cash":7822.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INSERTION OF PULSE GENERATOR","code_information":[{"code":"Px00036110175","type":"CDM"},{"code":"33212","type":"HCPCS"}],"standard_charges":[{"gross_charge":8861.0,"discounted_cash":3101.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC UPGRADE OF PACEMAKER SYSTEM","code_information":[{"code":"Px00036110178","type":"CDM"},{"code":"33214","type":"HCPCS"}],"standard_charges":[{"gross_charge":11812.0,"discounted_cash":4134.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REPOSITION PACING-IMPLANTABLE DEFIB LEAD","code_information":[{"code":"Px00036110179","type":"CDM"},{"code":"33215","type":"HCPCS"}],"standard_charges":[{"gross_charge":6840.0,"discounted_cash":2394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12265.0,"discounted_cash":4292.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12510.0,"discounted_cash":4378.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":8228.0,"discounted_cash":2879.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5991.0,"discounted_cash":2096.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RELOCATION POCKET PACEMAKER","code_information":[{"code":"Px00036110184","type":"CDM"},{"code":"33222","type":"HCPCS"}],"standard_charges":[{"gross_charge":4692.0,"discounted_cash":1642.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RELOCATE POCKET FOR IMPLANTABLE DEFIB","code_information":[{"code":"Px00036110185","type":"CDM"},{"code":"33223","type":"HCPCS"}],"standard_charges":[{"gross_charge":4092.0,"discounted_cash":1432.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INSERT PACING LEAD & CONNECT","code_information":[{"code":"Px00036110186","type":"CDM"},{"code":"33224","type":"HCPCS"}],"standard_charges":[{"gross_charge":31964.0,"discounted_cash":11187.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5460.0,"discounted_cash":1911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REPOSITION L VENTRIC LEAD","code_information":[{"code":"Px00036110188","type":"CDM"},{"code":"33226","type":"HCPCS"}],"standard_charges":[{"gross_charge":10949.0,"discounted_cash":3832.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REMOVAL OF PACEMAKER SYSTEM","code_information":[{"code":"Px00036110189","type":"CDM"},{"code":"33233","type":"HCPCS"}],"standard_charges":[{"gross_charge":10911.0,"discounted_cash":3818.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REMOVE PACER PERM SINGLE LEAD","code_information":[{"code":"Px00036110191","type":"CDM"},{"code":"33234","type":"HCPCS"}],"standard_charges":[{"gross_charge":5094.0,"discounted_cash":1782.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REMOVAL PACEMAKER ELECTRODE","code_information":[{"code":"Px00036110192","type":"CDM"},{"code":"33235","type":"HCPCS"}],"standard_charges":[{"gross_charge":5094.0,"discounted_cash":1782.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INSERT PULSE GENERATOR","code_information":[{"code":"Px00036110193","type":"CDM"},{"code":"33240","type":"HCPCS"}],"standard_charges":[{"gross_charge":9204.0,"discounted_cash":3221.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REMOVE PULSE GENERATOR","code_information":[{"code":"Px00036110194","type":"CDM"},{"code":"33241","type":"HCPCS"}],"standard_charges":[{"gross_charge":9204.0,"discounted_cash":3221.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REMOVE ELTRD TRANSVEN","code_information":[{"code":"Px00036110195","type":"CDM"},{"code":"33244","type":"HCPCS"}],"standard_charges":[{"gross_charge":7859.0,"discounted_cash":2750.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ELTRD/INSERT PACE-DEFIB","code_information":[{"code":"Px00036110196","type":"CDM"},{"code":"33249","type":"HCPCS"}],"standard_charges":[{"gross_charge":21628.0,"discounted_cash":7569.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ/LESS THAN 3CM","code_information":[{"code":"Px00036110208","type":"CDM"},{"code":"22902","type":"HCPCS"}],"standard_charges":[{"gross_charge":7205.0,"discounted_cash":2521.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","code_information":[{"code":"Px00036110217","type":"CDM"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EXCISION NAIL MATRIX PERMANENT REMOVAL","code_information":[{"code":"Px00036110236","type":"CDM"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4371.0,"discounted_cash":1529.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":762.0,"discounted_cash":266.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2187.0,"discounted_cash":765.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5428.0,"discounted_cash":1899.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2756.0,"discounted_cash":964.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TANGENTIAL BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00036110248","type":"CDM"},{"code":"11102","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":354.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PUNCH BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00036110250","type":"CDM"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":354.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INCISIONAL BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00036110252","type":"CDM"},{"code":"11106","type":"HCPCS"}],"standard_charges":[{"gross_charge":1437.0,"discounted_cash":502.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":331.0,"discounted_cash":115.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":42314.0,"discounted_cash":14809.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12469.0,"discounted_cash":4364.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5071.0,"discounted_cash":1774.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR","code_information":[{"code":"Px00036110257","type":"CDM"},{"code":"33286","type":"HCPCS"}],"standard_charges":[{"gross_charge":3338.0,"discounted_cash":1168.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR","code_information":[{"code":"Px00036110258","type":"CDM"},{"code":"33289","type":"HCPCS"}],"standard_charges":[{"gross_charge":27546.0,"discounted_cash":9641.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3644.0,"discounted_cash":1275.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4178.0,"discounted_cash":1462.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG","code_information":[{"code":"Px00036110262","type":"CDM"},{"code":"50436","type":"HCPCS"}],"standard_charges":[{"gross_charge":16140.0,"discounted_cash":5649.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS","code_information":[{"code":"Px00036110263","type":"CDM"},{"code":"50437","type":"HCPCS"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":3685.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":314.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5832.0,"discounted_cash":2041.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC THERAPEUTIC APHERESIS PLATELETS CDM","code_information":[{"code":"Px00036110292","type":"CDM"},{"code":"36513","type":"HCPCS"}],"standard_charges":[{"gross_charge":6414.0,"discounted_cash":2244.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REMOVE AORTIC ASSIST DEVICE","code_information":[{"code":"Px00036110367","type":"CDM"},{"code":"33968","type":"HCPCS"}],"standard_charges":[{"gross_charge":2368.0,"discounted_cash":828.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PSEUDOANEURYSM INJECTION TRT","code_information":[{"code":"Px00036110385","type":"CDM"},{"code":"36002","type":"HCPCS"}],"standard_charges":[{"gross_charge":4052.0,"discounted_cash":1418.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INJECTION EXT VENOGRAPHY","code_information":[{"code":"Px00036110386","type":"CDM"},{"code":"36005","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PLACE CATHETER IN VEIN","code_information":[{"code":"Px00036110388","type":"CDM"},{"code":"36010","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.0,"discounted_cash":277.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC VENOUS PLACEMENT 1ST ORDER","code_information":[{"code":"Px00036110389","type":"CDM"},{"code":"36011","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SLCT CATH 2ND VENOUS","code_information":[{"code":"Px00036110390","type":"CDM"},{"code":"36012","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":588.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RT/LT PULMONARY PLACEMENT","code_information":[{"code":"Px00036110392","type":"CDM"},{"code":"36014","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SELECT SEGMENTAL PULMONARY ART","code_information":[{"code":"Px00036110393","type":"CDM"},{"code":"36015","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTRO CATH EXTRM ART","code_information":[{"code":"Px00036110397","type":"CDM"},{"code":"36140","type":"HCPCS"}],"standard_charges":[{"gross_charge":668.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESTABLISH ACCESS TO AORTA","code_information":[{"code":"Px00036110401","type":"CDM"},{"code":"36160","type":"HCPCS"}],"standard_charges":[{"gross_charge":1878.0,"discounted_cash":657.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PLACE CATHETER IN AORTA","code_information":[{"code":"Px00036110402","type":"CDM"},{"code":"36200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2814.0,"discounted_cash":984.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":918.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BRACHIOCEPHALIC ANGIO 2ND ORDER","code_information":[{"code":"Px00036110404","type":"CDM"},{"code":"36216","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BRACHIOCEPHALIC ANGIO ADDT","code_information":[{"code":"Px00036110406","type":"CDM"},{"code":"36218","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ABD/PELVIC ANGIO 1ST ORDER","code_information":[{"code":"Px00036110408","type":"CDM"},{"code":"36245","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.0,"discounted_cash":192.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ABD/PELVIC ANGIO 2ND ORDER","code_information":[{"code":"Px00036110409","type":"CDM"},{"code":"36246","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.0,"discounted_cash":192.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ABD/PELVIC ANGIO 3RD ORDER","code_information":[{"code":"Px00036110410","type":"CDM"},{"code":"36247","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.0,"discounted_cash":192.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ABD/PELVIC ANGIO ADDT","code_information":[{"code":"Px00036110411","type":"CDM"},{"code":"36248","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM","code_information":[{"code":"Px00036110412","type":"CDM"},{"code":"11401","type":"HCPCS"}],"standard_charges":[{"gross_charge":1741.0,"discounted_cash":609.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4980.0,"discounted_cash":1743.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM","code_information":[{"code":"Px00036110419","type":"CDM"},{"code":"11404","type":"HCPCS"}],"standard_charges":[{"gross_charge":3445.0,"discounted_cash":1205.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":15684.0,"discounted_cash":5489.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INSERT TUNNELED CV CATH > 5","code_information":[{"code":"Px00036110425","type":"CDM"},{"code":"36558","type":"HCPCS"}],"standard_charges":[{"gross_charge":7851.0,"discounted_cash":2747.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":18774.0,"discounted_cash":6570.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3858.0,"discounted_cash":1350.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4422.0,"discounted_cash":1547.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6368.0,"discounted_cash":2228.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REPLACE NON TUNNEL CVAD CATH","code_information":[{"code":"Px00036110440","type":"CDM"},{"code":"36580","type":"HCPCS"}],"standard_charges":[{"gross_charge":3443.0,"discounted_cash":1205.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":17760.0,"discounted_cash":6216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REPLACE TUNNELED CV ACCESS DEVICE","code_information":[{"code":"Px00036110442","type":"CDM"},{"code":"36582","type":"HCPCS"}],"standard_charges":[{"gross_charge":16143.0,"discounted_cash":5650.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COMPLETE REPLACEMENT PICC RS&I","code_information":[{"code":"Px00036110443","type":"CDM"},{"code":"36584","type":"HCPCS"}],"standard_charges":[{"gross_charge":7774.0,"discounted_cash":2720.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1657.0,"discounted_cash":579.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7271.0,"discounted_cash":2544.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3858.0,"discounted_cash":1350.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4266.0,"discounted_cash":1493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":935.0,"discounted_cash":327.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","code_information":[{"code":"Px00036110456","type":"CDM"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INSERTION CATHETER ARTERY CDM","code_information":[{"code":"Px00036110457","type":"CDM"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":760.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2268.0,"discounted_cash":793.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9089.0,"discounted_cash":3181.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INSERT HEPATIC SHUNT (TIPS)","code_information":[{"code":"Px00036110474","type":"CDM"},{"code":"37182","type":"HCPCS"}],"standard_charges":[{"gross_charge":70026.0,"discounted_cash":24509.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PRIM ART MECH THROMBECTOMY","code_information":[{"code":"Px00036110476","type":"CDM"},{"code":"37184","type":"HCPCS"}],"standard_charges":[{"gross_charge":36139.0,"discounted_cash":12648.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":36139.0,"discounted_cash":12648.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":36139.0,"discounted_cash":12648.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC VENOUS MECH THROMBECTOMY","code_information":[{"code":"Px00036110479","type":"CDM"},{"code":"37187","type":"HCPCS"}],"standard_charges":[{"gross_charge":36139.0,"discounted_cash":12648.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC VENOUS M-THROMBECTOMY ADD-ON","code_information":[{"code":"Px00036110480","type":"CDM"},{"code":"37188","type":"HCPCS"}],"standard_charges":[{"gross_charge":36139.0,"discounted_cash":12648.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC THROMBOLYTIC THERAPY STROKE","code_information":[{"code":"Px00036110481","type":"CDM"},{"code":"37195","type":"HCPCS"}],"standard_charges":[{"gross_charge":762.0,"discounted_cash":266.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TRANSCATH STENT CCA W/EPS","code_information":[{"code":"Px00036110493","type":"CDM"},{"code":"37215","type":"HCPCS"}],"standard_charges":[{"gross_charge":80782.0,"discounted_cash":28273.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ILIAC REVASC","code_information":[{"code":"Px00036110495","type":"CDM"},{"code":"37220","type":"HCPCS"}],"standard_charges":[{"gross_charge":10298.0,"discounted_cash":3604.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ILIAC REVASC W/STENT","code_information":[{"code":"Px00036110496","type":"CDM"},{"code":"37221","type":"HCPCS"}],"standard_charges":[{"gross_charge":15829.0,"discounted_cash":5540.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ILIAC REVASC ADD-ON","code_information":[{"code":"Px00036110497","type":"CDM"},{"code":"37222","type":"HCPCS"}],"standard_charges":[{"gross_charge":5698.0,"discounted_cash":1994.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5698.0,"discounted_cash":1994.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FEM/POPL REVAS W/TLA","code_information":[{"code":"Px00036110499","type":"CDM"},{"code":"37224","type":"HCPCS"}],"standard_charges":[{"gross_charge":10298.0,"discounted_cash":3604.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FEM/POPL REVAS W/ATHER","code_information":[{"code":"Px00036110500","type":"CDM"},{"code":"37225","type":"HCPCS"}],"standard_charges":[{"gross_charge":13062.0,"discounted_cash":4571.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6414.0,"discounted_cash":2244.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FEM/POPL REVASC W/STENT","code_information":[{"code":"Px00036110502","type":"CDM"},{"code":"37226","type":"HCPCS"}],"standard_charges":[{"gross_charge":15829.0,"discounted_cash":5540.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FEM/POPL REVASC STNT & ATHER","code_information":[{"code":"Px00036110503","type":"CDM"},{"code":"37227","type":"HCPCS"}],"standard_charges":[{"gross_charge":21365.0,"discounted_cash":7477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TIB/PER REVASC W/TLA","code_information":[{"code":"Px00036110504","type":"CDM"},{"code":"37228","type":"HCPCS"}],"standard_charges":[{"gross_charge":20825.0,"discounted_cash":7288.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TIB/PER REVASC W/ATHER","code_information":[{"code":"Px00036110505","type":"CDM"},{"code":"37229","type":"HCPCS"}],"standard_charges":[{"gross_charge":32790.0,"discounted_cash":11476.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TIB/PER REVASC W/STENT","code_information":[{"code":"Px00036110506","type":"CDM"},{"code":"37230","type":"HCPCS"}],"standard_charges":[{"gross_charge":32790.0,"discounted_cash":11476.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TIB/PER REVASC STENT & ATHER","code_information":[{"code":"Px00036110507","type":"CDM"},{"code":"37231","type":"HCPCS"}],"standard_charges":[{"gross_charge":32790.0,"discounted_cash":11476.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TIB/PER REVASC ADD-ON","code_information":[{"code":"Px00036110508","type":"CDM"},{"code":"37232","type":"HCPCS"}],"standard_charges":[{"gross_charge":5698.0,"discounted_cash":1994.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5698.0,"discounted_cash":1994.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5698.0,"discounted_cash":1994.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LARYNGOSCOPY FLEXIBLE DIAGNOSTIC","code_information":[{"code":"Px00036110516","type":"CDM"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5091.0,"discounted_cash":1781.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7655.0,"discounted_cash":2679.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1891.0,"discounted_cash":661.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5490.0,"discounted_cash":1921.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BONE BIOPSY TROCAR/NEEDLE SUPERFICIAL","code_information":[{"code":"Px00036110558","type":"CDM"},{"code":"20220","type":"HCPCS"}],"standard_charges":[{"gross_charge":3860.0,"discounted_cash":1351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IR INJ TRIGGER POINT(S)1TO2 MUSC","code_information":[{"code":"Px00036110560","type":"CDM"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1104.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1436.0,"discounted_cash":502.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1824.0,"discounted_cash":638.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BIOPSY ARM/ELBOW SOFT TISSUE","code_information":[{"code":"Px00036110575","type":"CDM"},{"code":"24065","type":"HCPCS"}],"standard_charges":[{"gross_charge":3860.0,"discounted_cash":1351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DEB SUBQ TISSUE ADD-ON","code_information":[{"code":"Px00036110577","type":"CDM"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1824.0,"discounted_cash":638.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":27489.0,"discounted_cash":9621.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4779.0,"discounted_cash":1672.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1824.0,"discounted_cash":638.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DRAINAGE OF HEMATOMA/FLUID","code_information":[{"code":"Px00036110601","type":"CDM"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":3860.0,"discounted_cash":1351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":840.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BONE BIOPSY TROCAR/NEEDLE","code_information":[{"code":"Px00036110611","type":"CDM"},{"code":"20225","type":"HCPCS"}],"standard_charges":[{"gross_charge":7399.0,"discounted_cash":2589.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REMOVAL OF FOREIGN BODY","code_information":[{"code":"Px00036110613","type":"CDM"},{"code":"20525","type":"HCPCS"}],"standard_charges":[{"gross_charge":5525.0,"discounted_cash":1933.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DRAIN/INJECT JOINT/BURSA INTERMED","code_information":[{"code":"Px00036110614","type":"CDM"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DRAIN NECK/CHEST LESION","code_information":[{"code":"Px00036110618","type":"CDM"},{"code":"21501","type":"HCPCS"}],"standard_charges":[{"gross_charge":6503.0,"discounted_cash":2276.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TUBE THORACOSTOMY INCLUDES WATER SEAL","code_information":[{"code":"Px00036110622","type":"CDM"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":7616.0,"discounted_cash":2665.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REMOVE LUNG CATHETER","code_information":[{"code":"Px00036110623","type":"CDM"},{"code":"32552","type":"HCPCS"}],"standard_charges":[{"gross_charge":3402.0,"discounted_cash":1190.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CHEST SURGERY PROCEDURE","code_information":[{"code":"Px00036110624","type":"CDM"},{"code":"32999","type":"HCPCS"}],"standard_charges":[{"gross_charge":2299.0,"discounted_cash":804.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REMOVAL OF CLOT IN GRAFT","code_information":[{"code":"Px00036110640","type":"CDM"},{"code":"35875","type":"HCPCS"}],"standard_charges":[{"gross_charge":11394.0,"discounted_cash":3987.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTRODUCTION NEEDLE/INTRACATHETER VEIN","code_information":[{"code":"Px00036110641","type":"CDM"},{"code":"36000","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":96.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INJECTION THERAPY OF VEIN","code_information":[{"code":"Px00036110642","type":"CDM"},{"code":"36470","type":"HCPCS"}],"standard_charges":[{"gross_charge":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":277.0,"discounted_cash":96.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6928.0,"discounted_cash":2424.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PERC DILATION BILIARY W/ STENT","code_information":[{"code":"Px00036110657","type":"CDM"},{"code":"47556","type":"HCPCS"}],"standard_charges":[{"gross_charge":6928.0,"discounted_cash":2424.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NEEDLE BIOPSY PANCREAS","code_information":[{"code":"Px00036110659","type":"CDM"},{"code":"48102","type":"HCPCS"}],"standard_charges":[{"gross_charge":2065.0,"discounted_cash":722.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3202.0,"discounted_cash":1120.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BIOPSY ABDOMINAL MASS","code_information":[{"code":"Px00036110664","type":"CDM"},{"code":"49180","type":"HCPCS"}],"standard_charges":[{"gross_charge":3860.0,"discounted_cash":1351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INSERT TUN INTRAPERITONEAL CATH PERC","code_information":[{"code":"Px00036110667","type":"CDM"},{"code":"49418","type":"HCPCS"}],"standard_charges":[{"gross_charge":20382.0,"discounted_cash":7133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REMOVE TUNNELED IP CATH","code_information":[{"code":"Px00036110670","type":"CDM"},{"code":"49422","type":"HCPCS"}],"standard_charges":[{"gross_charge":19324.0,"discounted_cash":6763.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EXCHANGE DRAINAGE CATHETER","code_information":[{"code":"Px00036110671","type":"CDM"},{"code":"49423","type":"HCPCS"}],"standard_charges":[{"gross_charge":21281.0,"discounted_cash":7448.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RENAL BIOPSY PERQ","code_information":[{"code":"Px00036110673","type":"CDM"},{"code":"50200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3860.0,"discounted_cash":1351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DRAINAGE OF KIDNEY LESION","code_information":[{"code":"Px00036110677","type":"CDM"},{"code":"50390","type":"HCPCS"}],"standard_charges":[{"gross_charge":1372.0,"discounted_cash":480.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DRAIN BLADDER W/CATH INSERTION","code_information":[{"code":"Px00036110683","type":"CDM"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":4912.0,"discounted_cash":1719.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CYSTOSTOMY TUBE CHANGE","code_information":[{"code":"Px00036110687","type":"CDM"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":324.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CHANGE OF BLADDER TUBE","code_information":[{"code":"Px00036110688","type":"CDM"},{"code":"51710","type":"HCPCS"}],"standard_charges":[{"gross_charge":2268.0,"discounted_cash":793.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DILATE URETHRA STRICTURE","code_information":[{"code":"Px00036110691","type":"CDM"},{"code":"53600","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":173.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTERDISCAL PERQ ASPIR DX","code_information":[{"code":"Px00036110700","type":"CDM"},{"code":"62267","type":"HCPCS"}],"standard_charges":[{"gross_charge":3287.0,"discounted_cash":1150.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DRAIN CEREBRO SPINAL FLUID","code_information":[{"code":"Px00036110702","type":"CDM"},{"code":"62272","type":"HCPCS"}],"standard_charges":[{"gross_charge":1185.0,"discounted_cash":414.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INJECTION AA&/STRD SCIATIC NERVE W/IMG GDN CDM","code_information":[{"code":"Px00036110716","type":"CDM"},{"code":"64445","type":"HCPCS"}],"standard_charges":[{"gross_charge":2170.0,"discounted_cash":759.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC N BLOCK INJ FEM SINGLE","code_information":[{"code":"Px00036110717","type":"CDM"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":2585.0,"discounted_cash":904.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5662.0,"discounted_cash":1981.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2763.0,"discounted_cash":967.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2461.0,"discounted_cash":861.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1349.0,"discounted_cash":472.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1056.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC N BLOCK LUMBAR/THORACIC","code_information":[{"code":"Px00036110733","type":"CDM"},{"code":"64520","type":"HCPCS"}],"standard_charges":[{"gross_charge":6202.0,"discounted_cash":2170.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC N BLOCK INJ CELIAC PLEXUS","code_information":[{"code":"Px00036110734","type":"CDM"},{"code":"64530","type":"HCPCS"}],"standard_charges":[{"gross_charge":4858.0,"discounted_cash":1700.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9988.0,"discounted_cash":3495.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1436.0,"discounted_cash":502.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TREAT PLEURODESIS W/AGENT","code_information":[{"code":"Px00036110912","type":"CDM"},{"code":"32560","type":"HCPCS"}],"standard_charges":[{"gross_charge":1071.0,"discounted_cash":374.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT","code_information":[{"code":"Px00036110920","type":"CDM"},{"code":"43212","type":"HCPCS"}],"standard_charges":[{"gross_charge":16443.0,"discounted_cash":5755.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NEEDLE BIOPSY LYMPH NODES","code_information":[{"code":"Px00036110934","type":"CDM"},{"code":"38505","type":"HCPCS"}],"standard_charges":[{"gross_charge":3860.0,"discounted_cash":1351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC THERAPEUTIC APHERESIS PLASMA PHERESIS CDM","code_information":[{"code":"Px00036110977","type":"CDM"},{"code":"36514","type":"HCPCS"}],"standard_charges":[{"gross_charge":20024.0,"discounted_cash":7008.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MEASURE KIDNEY PRESSURE","code_information":[{"code":"Px00036111007","type":"CDM"},{"code":"50396","type":"HCPCS"}],"standard_charges":[{"gross_charge":947.0,"discounted_cash":331.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CHANGE OF URETER TUBE/STENT","code_information":[{"code":"Px00036111015","type":"CDM"},{"code":"50688","type":"HCPCS"}],"standard_charges":[{"gross_charge":4912.0,"discounted_cash":1719.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9932.0,"discounted_cash":3476.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DRAINAGE OF OVARIAN CYST(S), ABDOMINAL APPROACH","code_information":[{"code":"Px00036111034","type":"CDM"},{"code":"58805","type":"HCPCS"}],"standard_charges":[{"gross_charge":14140.0,"discounted_cash":4949.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2585.0,"discounted_cash":904.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6785.0,"discounted_cash":2374.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DELIVERY PLACENTA SEPARATE PROCEDURE CDM","code_information":[{"code":"Px00036111084","type":"CDM"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":3560.0,"discounted_cash":1246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1657.0,"discounted_cash":579.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2131.0,"discounted_cash":745.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6622.0,"discounted_cash":2317.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6787.0,"discounted_cash":2375.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10250.0,"discounted_cash":3587.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":16702.0,"discounted_cash":5845.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":23174.0,"discounted_cash":8110.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":30545.0,"discounted_cash":10690.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11584.0,"discounted_cash":4054.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":14042.0,"discounted_cash":4914.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3445.0,"discounted_cash":1205.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1854.0,"discounted_cash":648.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":20392.0,"discounted_cash":7137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":16179.0,"discounted_cash":5662.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX","code_information":[{"code":"Px00036111140","type":"CDM"},{"code":"37213","type":"HCPCS"}],"standard_charges":[{"gross_charge":23948.0,"discounted_cash":8381.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":23948.0,"discounted_cash":8381.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2469.0,"discounted_cash":864.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REMOVAL PERCUTANEOUS VAD DIFFERENT SESSION","code_information":[{"code":"Px00036111152","type":"CDM"},{"code":"33992","type":"HCPCS"}],"standard_charges":[{"gross_charge":2469.0,"discounted_cash":864.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1079.0,"discounted_cash":377.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2268.0,"discounted_cash":793.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6806.0,"discounted_cash":2382.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BX BREAST 1ST LESION STEREO","code_information":[{"code":"Px00036111183","type":"CDM"},{"code":"19081","type":"HCPCS"}],"standard_charges":[{"gross_charge":8649.0,"discounted_cash":3027.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BX BREAST ADD LESION STEREO","code_information":[{"code":"Px00036111184","type":"CDM"},{"code":"19082","type":"HCPCS"}],"standard_charges":[{"gross_charge":4842.0,"discounted_cash":1694.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12375.0,"discounted_cash":4331.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4822.0,"discounted_cash":1687.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12719.0,"discounted_cash":4451.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6360.0,"discounted_cash":2226.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3741.0,"discounted_cash":1309.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1874.0,"discounted_cash":655.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5434.0,"discounted_cash":1901.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2719.0,"discounted_cash":951.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11368.0,"discounted_cash":3978.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3818.0,"discounted_cash":1336.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11012.0,"discounted_cash":3854.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5509.0,"discounted_cash":1928.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1436.0,"discounted_cash":502.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2846.0,"discounted_cash":996.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4412.0,"discounted_cash":1544.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PERQ CERVICOTHORACIC INJECT","code_information":[{"code":"Px00036111222","type":"CDM"},{"code":"22510","type":"HCPCS"}],"standard_charges":[{"gross_charge":16430.0,"discounted_cash":5750.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PERQ LUMBOSACRAL INJECTION","code_information":[{"code":"Px00036111223","type":"CDM"},{"code":"22511","type":"HCPCS"}],"standard_charges":[{"gross_charge":16430.0,"discounted_cash":5750.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC VERTEBROPLASTY ADDL INJECT","code_information":[{"code":"Px00036111224","type":"CDM"},{"code":"22512","type":"HCPCS"}],"standard_charges":[{"gross_charge":29476.0,"discounted_cash":10316.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":36849.0,"discounted_cash":12897.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":36849.0,"discounted_cash":12897.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":29476.0,"discounted_cash":10316.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":24604.0,"discounted_cash":8611.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INSJ SUBQ IMPLTBL DFB ELCTRD","code_information":[{"code":"Px00036111229","type":"CDM"},{"code":"33271","type":"HCPCS"}],"standard_charges":[{"gross_charge":7035.0,"discounted_cash":2462.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RMVL OF SUBQ DEFIBRILLATOR","code_information":[{"code":"Px00036111230","type":"CDM"},{"code":"33272","type":"HCPCS"}],"standard_charges":[{"gross_charge":5868.0,"discounted_cash":2053.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REPOS PREV IMPLTBL SUBQ DFB","code_information":[{"code":"Px00036111231","type":"CDM"},{"code":"33273","type":"HCPCS"}],"standard_charges":[{"gross_charge":5868.0,"discounted_cash":2053.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6371.0,"discounted_cash":2229.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6168.0,"discounted_cash":2158.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6168.0,"discounted_cash":2158.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7379.0,"discounted_cash":2582.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1743.0,"discounted_cash":610.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR WRIST ARTHROGRAPHY","code_information":[{"code":"Px00036112004","type":"CDM"},{"code":"25246","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BIOPSY OF SOFT TISSUES DEEP","code_information":[{"code":"Px00036112006","type":"CDM"},{"code":"27041","type":"HCPCS"}],"standard_charges":[{"gross_charge":5580.0,"discounted_cash":1953.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INJECTION PROC FOR ANKLE ARTHROGRAM","code_information":[{"code":"Px00036112017","type":"CDM"},{"code":"27648","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":133.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INSERT DUAL CHAMBER PACER","code_information":[{"code":"Px00036112024","type":"CDM"},{"code":"33213","type":"HCPCS"}],"standard_charges":[{"gross_charge":11812.0,"discounted_cash":4134.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INS TEMP CARD ELECTRODES DUAL","code_information":[{"code":"Px00036112025","type":"CDM"},{"code":"33211","type":"HCPCS"}],"standard_charges":[{"gross_charge":19208.0,"discounted_cash":6722.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LOW COST SKIN SUB APP TO TRUNK/ARMS/LEGS TO 100 SQ CM 1ST 25 SQ CM","code_information":[{"code":"Px00036112029","type":"CDM"},{"code":"C5271","type":"HCPCS"}],"standard_charges":[{"gross_charge":3492.0,"discounted_cash":1222.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LOW COST SKIN SUB APP TO TRNK/ARMS/LEGS TO 100 SQ CM EA ADD 25 SQ CM","code_information":[{"code":"Px00036112030","type":"CDM"},{"code":"C5272","type":"HCPCS"}],"standard_charges":[{"gross_charge":627.0,"discounted_cash":219.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LOW COST SKIN SUB APP TO TRNK/ARMS/LEGS > 100 SQ CM 1ST 100 SQ CM","code_information":[{"code":"Px00036112031","type":"CDM"},{"code":"C5273","type":"HCPCS"}],"standard_charges":[{"gross_charge":4886.0,"discounted_cash":1710.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LOW COST SKIN SUB APP TO TRNK/ARMS/LEGS > 100 SQ CM EA ADD 100 SQ CM","code_information":[{"code":"Px00036112032","type":"CDM"},{"code":"C5274","type":"HCPCS"}],"standard_charges":[{"gross_charge":1505.0,"discounted_cash":526.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LOW COST SKIN SUB APP TO FACE/NECK/HAND/FEET TO 100 SQ CM 1ST 25 SQ CM","code_information":[{"code":"Px00036112033","type":"CDM"},{"code":"C5275","type":"HCPCS"}],"standard_charges":[{"gross_charge":3492.0,"discounted_cash":1222.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LOW COST SKIN SUB APP TO FACE/NECK/HAND/FEET TO 100 SQ CM EA ADD 25 SQCM","code_information":[{"code":"Px00036112034","type":"CDM"},{"code":"C5276","type":"HCPCS"}],"standard_charges":[{"gross_charge":627.0,"discounted_cash":219.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LOW COST SKIN SUBST APP TO FACE/NECK/HAND/FEET > 100 SQ CM 1ST 100 SQ CM","code_information":[{"code":"Px00036112035","type":"CDM"},{"code":"C5277","type":"HCPCS"}],"standard_charges":[{"gross_charge":3492.0,"discounted_cash":1222.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LOW COST SKIN SUB APP TO FACE/NECK/HAND/FEET > 100 SQ CM EA ADD 100 SQCM","code_information":[{"code":"Px00036112036","type":"CDM"},{"code":"C5278","type":"HCPCS"}],"standard_charges":[{"gross_charge":627.0,"discounted_cash":219.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TRABECULOPLASTY BY LASER SURGERY","code_information":[{"code":"Px00036112051","type":"CDM"},{"code":"65855","type":"HCPCS"}],"standard_charges":[{"gross_charge":1431.0,"discounted_cash":500.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC AMPUTATIONTOEMETATARSOPHALANGEAL JOINT","code_information":[{"code":"Px00036112052","type":"CDM"},{"code":"28820","type":"HCPCS"}],"standard_charges":[{"gross_charge":7767.0,"discounted_cash":2718.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC AMPUTATION TOE INTERPHALANGEAL JOINT","code_information":[{"code":"Px00036112053","type":"CDM"},{"code":"28825","type":"HCPCS"}],"standard_charges":[{"gross_charge":7767.0,"discounted_cash":2718.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INCISION OF TOE TENDON","code_information":[{"code":"Px00036112054","type":"CDM"},{"code":"28010","type":"HCPCS"}],"standard_charges":[{"gross_charge":3492.0,"discounted_cash":1222.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12280.0,"discounted_cash":4298.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":13942.0,"discounted_cash":4879.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC THROMBECT DIALYSIS CIRCUIT","code_information":[{"code":"Px00036114036","type":"CDM"},{"code":"36904","type":"HCPCS"}],"standard_charges":[{"gross_charge":11842.0,"discounted_cash":4144.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC THROMBECT DIALY CIRCUIT W/BALN","code_information":[{"code":"Px00036114037","type":"CDM"},{"code":"36905","type":"HCPCS"}],"standard_charges":[{"gross_charge":23999.0,"discounted_cash":8399.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":21324.0,"discounted_cash":7463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ANGIOPLASTY BALLN DIALY CIRC","code_information":[{"code":"Px00036114039","type":"CDM"},{"code":"36907","type":"HCPCS"}],"standard_charges":[{"gross_charge":5331.0,"discounted_cash":1865.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5331.0,"discounted_cash":1865.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EMBOLIZATION/OCCLU DIALY CIRC","code_information":[{"code":"Px00036114041","type":"CDM"},{"code":"36909","type":"HCPCS"}],"standard_charges":[{"gross_charge":5331.0,"discounted_cash":1865.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ANGIOPLAST BALLN TRNSL 1ST ART","code_information":[{"code":"Px00036114042","type":"CDM"},{"code":"37246","type":"HCPCS"}],"standard_charges":[{"gross_charge":12280.0,"discounted_cash":4298.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ANGIOPLAST BLLN TRNSL ADDL ART","code_information":[{"code":"Px00036114043","type":"CDM"},{"code":"37247","type":"HCPCS"}],"standard_charges":[{"gross_charge":2790.0,"discounted_cash":976.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ANGIOPLAST BLLN TRNSL 1ST VEIN","code_information":[{"code":"Px00036114044","type":"CDM"},{"code":"37248","type":"HCPCS"}],"standard_charges":[{"gross_charge":11842.0,"discounted_cash":4144.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ANGIOPLAST BLLN TRNS ADDL VEIN","code_information":[{"code":"Px00036114045","type":"CDM"},{"code":"37249","type":"HCPCS"}],"standard_charges":[{"gross_charge":2790.0,"discounted_cash":976.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3747.0,"discounted_cash":1311.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2585.0,"discounted_cash":904.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3614.0,"discounted_cash":1264.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EPIDURAL BLOOD PATCH","code_information":[{"code":"Px00036119030","type":"CDM"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":3024.0,"discounted_cash":1058.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2704.0,"discounted_cash":946.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PERQ DEV SOFT TISS ADDL IMAG","code_information":[{"code":"Px00036119072","type":"CDM"},{"code":"10036","type":"HCPCS"}],"standard_charges":[{"gross_charge":1503.0,"discounted_cash":526.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTRVASC US NONCORONARY 1ST","code_information":[{"code":"Px00036119076","type":"CDM"},{"code":"37252","type":"HCPCS"}],"standard_charges":[{"gross_charge":3147.0,"discounted_cash":1101.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTRVASC US NONCORONARY ADDL","code_information":[{"code":"Px00036119077","type":"CDM"},{"code":"37253","type":"HCPCS"}],"standard_charges":[{"gross_charge":2146.0,"discounted_cash":751.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR CHOLANGIOGRAM, EXISTING ACCESS","code_information":[{"code":"Px00036119078","type":"CDM"},{"code":"47531","type":"HCPCS"}],"standard_charges":[{"gross_charge":11392.0,"discounted_cash":3987.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR CHOLANGIOGRAM, NEW ACCESS","code_information":[{"code":"Px00036119079","type":"CDM"},{"code":"47532","type":"HCPCS"}],"standard_charges":[{"gross_charge":11392.0,"discounted_cash":3987.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PLMT BILIARY DRAINAGE CATH, EXTERNAL","code_information":[{"code":"Px00036119080","type":"CDM"},{"code":"47533","type":"HCPCS"}],"standard_charges":[{"gross_charge":9179.0,"discounted_cash":3212.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9179.0,"discounted_cash":3212.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CONVERSION EXT BIL DRG CATH","code_information":[{"code":"Px00036119082","type":"CDM"},{"code":"47535","type":"HCPCS"}],"standard_charges":[{"gross_charge":17570.0,"discounted_cash":6149.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EXCHANGE BILIARY DRG CATH","code_information":[{"code":"Px00036119083","type":"CDM"},{"code":"47536","type":"HCPCS"}],"standard_charges":[{"gross_charge":17570.0,"discounted_cash":6149.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REMOVAL BILIARY DRG CATH","code_information":[{"code":"Px00036119084","type":"CDM"},{"code":"47537","type":"HCPCS"}],"standard_charges":[{"gross_charge":6032.0,"discounted_cash":2111.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9501.0,"discounted_cash":3325.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":18184.0,"discounted_cash":6364.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":18184.0,"discounted_cash":6364.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":17570.0,"discounted_cash":6149.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DILATE BILIARY DUCT/AMPULLA. EA DUCT","code_information":[{"code":"Px00036119089","type":"CDM"},{"code":"47542","type":"HCPCS"}],"standard_charges":[{"gross_charge":8782.0,"discounted_cash":3073.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SCLEROTX FLUID COLLECTION","code_information":[{"code":"Px00036119091","type":"CDM"},{"code":"49185","type":"HCPCS"}],"standard_charges":[{"gross_charge":6793.0,"discounted_cash":2377.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3568.0,"discounted_cash":1248.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3440.0,"discounted_cash":1204.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PLMT NEPHROSTOMY CATHETER","code_information":[{"code":"Px00036119094","type":"CDM"},{"code":"50432","type":"HCPCS"}],"standard_charges":[{"gross_charge":14436.0,"discounted_cash":5052.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PLMT NEPHROURETERAL CATHETER, NEW ACCESS","code_information":[{"code":"Px00036119095","type":"CDM"},{"code":"50433","type":"HCPCS"}],"standard_charges":[{"gross_charge":13922.0,"discounted_cash":4872.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10055.0,"discounted_cash":3519.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EXCHANGE NEPHROSTOMY CATH","code_information":[{"code":"Px00036119097","type":"CDM"},{"code":"50435","type":"HCPCS"}],"standard_charges":[{"gross_charge":4364.0,"discounted_cash":1527.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9455.0,"discounted_cash":3309.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9455.0,"discounted_cash":3309.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9455.0,"discounted_cash":3309.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BALLOON DILATE URTRL STRIX","code_information":[{"code":"Px00036119103","type":"CDM"},{"code":"50706","type":"HCPCS"}],"standard_charges":[{"gross_charge":2014.0,"discounted_cash":704.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2605.0,"discounted_cash":911.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":406.0,"discounted_cash":142.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":406.0,"discounted_cash":142.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":406.0,"discounted_cash":142.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":406.0,"discounted_cash":142.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":406.0,"discounted_cash":142.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CRYOPRECIPITATE EACH UNIT","code_information":[{"code":"Px00039010002","type":"CDM"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":665.0,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLOOD SPLIT UNIT RBC","code_information":[{"code":"Px00039010013","type":"CDM"},{"code":"P9011","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RBC LEUKOREDUCED","code_information":[{"code":"Px00039010015","type":"CDM"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":178.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":143.0,"discounted_cash":50.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC AUTOLOGOUS RED BLOOD CELLS UNIT","code_information":[{"code":"Px00039010021","type":"CDM"},{"code":"P9021","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":121.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RED BLOOD CELLS UNIT","code_information":[{"code":"Px00039010022","type":"CDM"},{"code":"P9021","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PLATELET PHERESIS","code_information":[{"code":"Px00039010030","type":"CDM"},{"code":"P9034","type":"HCPCS"}],"standard_charges":[{"gross_charge":938.0,"discounted_cash":328.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PLATELET PHERESIS LEUKOREDUCED","code_information":[{"code":"Px00039010031","type":"CDM"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":938.0,"discounted_cash":328.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PLATELET PHERESIS LEUKOREDU IRRAD","code_information":[{"code":"Px00039010033","type":"CDM"},{"code":"P9037","type":"HCPCS"}],"standard_charges":[{"gross_charge":938.0,"discounted_cash":328.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RBC DEGLYCEROLIZED","code_information":[{"code":"Px00039010035","type":"CDM"},{"code":"P9039","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CRYOPRECIPITATE REDUCED PLASMA","code_information":[{"code":"Px00039010036","type":"CDM"},{"code":"P9044","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":85.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RBC LEUKORED IRRAD CMV NEG EA","code_information":[{"code":"Px00039010044","type":"CDM"},{"code":"P9058","type":"HCPCS"}],"standard_charges":[{"gross_charge":755.0,"discounted_cash":264.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":143.0,"discounted_cash":50.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CRYOPRECIPITATE EACH UNIT POOLED","code_information":[{"code":"Px00039010054","type":"CDM"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":46.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RBC LEUKOREDUCED IRRADIATED","code_information":[{"code":"Px00039010055","type":"CDM"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":392.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2044.0,"discounted_cash":715.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1297.0,"discounted_cash":453.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLOOD SPLIT UNIT PLASMA","code_information":[{"code":"Px00039910001","type":"CDM"},{"code":"P9011","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLOOD SPLIT UNIT PLATELET PHERESIS","code_information":[{"code":"Px00039910002","type":"CDM"},{"code":"P9011","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MAMMO DIAG BIL W CAD","code_information":[{"code":"Px00040110004","type":"CDM"},{"code":"77066","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.0,"discounted_cash":502.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":420.0,"discounted_cash":147.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MAMMO DIAG UNI W CAD","code_information":[{"code":"Px00040110005","type":"CDM"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":366.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":336.0,"discounted_cash":117.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC SCREENING BREAST TOMOSYNTHESIS BI","code_information":[{"code":"Px00040110020","type":"CDM"},{"code":"77063","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":54.0,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ECHO EXAM OF HEAD","code_information":[{"code":"Px00040210001","type":"CDM"},{"code":"76506","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.0,"discounted_cash":502.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2475.0,"discounted_cash":866.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US EXAM CHEST","code_information":[{"code":"Px00040210005","type":"CDM"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":2015.0,"discounted_cash":705.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US EXAM ABDOMEN COMPLETE","code_information":[{"code":"Px00040210008","type":"CDM"},{"code":"76700","type":"HCPCS"}],"standard_charges":[{"gross_charge":3284.0,"discounted_cash":1149.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US EXAM PELVIC LIMITED","code_information":[{"code":"Px00040210009","type":"CDM"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":193.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US RETROPERITONEAL COMPLETE","code_information":[{"code":"Px00040210010","type":"CDM"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":2475.0,"discounted_cash":866.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US RETROPERITONEAL LIMITED","code_information":[{"code":"Px00040210011","type":"CDM"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1667.0,"discounted_cash":583.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2388.0,"discounted_cash":835.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US SPINAL CANAL","code_information":[{"code":"Px00040210013","type":"CDM"},{"code":"76800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1391.0,"discounted_cash":486.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1423.0,"discounted_cash":498.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1423.0,"discounted_cash":498.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1655.0,"discounted_cash":579.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1411.0,"discounted_cash":493.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1426.0,"discounted_cash":499.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US OB FOLLOW-UP PER FETUS CDM","code_information":[{"code":"Px00040210023","type":"CDM"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1426.0,"discounted_cash":499.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US OB TRANSVAGINAL CDM","code_information":[{"code":"Px00040210024","type":"CDM"},{"code":"76817","type":"HCPCS"}],"standard_charges":[{"gross_charge":2475.0,"discounted_cash":866.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2208.0,"discounted_cash":772.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2208.0,"discounted_cash":772.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US TRANSVAGINAL NON-OB","code_information":[{"code":"Px00040210033","type":"CDM"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":2475.0,"discounted_cash":866.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ECHO EXAM UTERUS","code_information":[{"code":"Px00040210034","type":"CDM"},{"code":"76831","type":"HCPCS"}],"standard_charges":[{"gross_charge":920.0,"discounted_cash":322.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US EXAM PELVIC FOLLICLE LIMITED","code_information":[{"code":"Px00040210035","type":"CDM"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":193.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US EXAM SCROTUM & CONTENTS","code_information":[{"code":"Px00040210036","type":"CDM"},{"code":"76870","type":"HCPCS"}],"standard_charges":[{"gross_charge":2977.0,"discounted_cash":1041.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US TRANSRECTAL","code_information":[{"code":"Px00040210037","type":"CDM"},{"code":"76872","type":"HCPCS"}],"standard_charges":[{"gross_charge":2121.0,"discounted_cash":742.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US TRANSRECTAL PROSTATE VOLUME","code_information":[{"code":"Px00040210038","type":"CDM"},{"code":"76873","type":"HCPCS"}],"standard_charges":[{"gross_charge":784.0,"discounted_cash":274.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US JOINT COMPLETE","code_information":[{"code":"Px00040210041","type":"CDM"},{"code":"76881","type":"HCPCS"}],"standard_charges":[{"gross_charge":2977.0,"discounted_cash":1041.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2231.0,"discounted_cash":780.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US INFANT HIPS DYNAMIC","code_information":[{"code":"Px00040210045","type":"CDM"},{"code":"76885","type":"HCPCS"}],"standard_charges":[{"gross_charge":1391.0,"discounted_cash":486.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US INFANT HIPS STATIC","code_information":[{"code":"Px00040210046","type":"CDM"},{"code":"76886","type":"HCPCS"}],"standard_charges":[{"gross_charge":695.0,"discounted_cash":243.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US GUIDE VASCULAR ACCESS","code_information":[{"code":"Px00040210049","type":"CDM"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":681.0,"discounted_cash":238.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2977.0,"discounted_cash":1041.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":897.0,"discounted_cash":313.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC US GUIDE INTERSTITIAL RADIOTHERAPY","code_information":[{"code":"Px00040210056","type":"CDM"},{"code":"76965","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.0,"discounted_cash":241.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US GUIDE INTRAOPERATIVE","code_information":[{"code":"Px00040210059","type":"CDM"},{"code":"76998","type":"HCPCS"}],"standard_charges":[{"gross_charge":932.0,"discounted_cash":326.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ECHO EXAMINATION PROCEDURE UNLISTED","code_information":[{"code":"Px00040210061","type":"CDM"},{"code":"76999","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US UMBILICAL ARTERY ECHO CDM","code_information":[{"code":"Px00040210076","type":"CDM"},{"code":"76820","type":"HCPCS"}],"standard_charges":[{"gross_charge":2854.0,"discounted_cash":998.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US PELVIC NON-OB COMPLETE","code_information":[{"code":"Px00040210093","type":"CDM"},{"code":"76856","type":"HCPCS"}],"standard_charges":[{"gross_charge":2816.0,"discounted_cash":985.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US ABDOMEN LIMITED","code_information":[{"code":"Px00040210104","type":"CDM"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1799.0,"discounted_cash":629.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2231.0,"discounted_cash":780.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2977.0,"discounted_cash":1041.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":897.0,"discounted_cash":313.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC US BREAST UNI COMPLETE","code_information":[{"code":"Px00040210136","type":"CDM"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":2475.0,"discounted_cash":866.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":377.0,"discounted_cash":131.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC US BREAST UNI LIMITED","code_information":[{"code":"Px00040210137","type":"CDM"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":1858.0,"discounted_cash":650.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":284.0,"discounted_cash":99.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC US ABD AORTA SCRN AAA","code_information":[{"code":"Px00040210142","type":"CDM"},{"code":"76706","type":"HCPCS"}],"standard_charges":[{"gross_charge":1137.0,"discounted_cash":397.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MAMMO SCREEN BIL W CAD","code_information":[{"code":"Px00040310004","type":"CDM"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":808.0,"discounted_cash":282.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":309.0,"discounted_cash":108.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MAMMO SCREEN UNIL/BIL W CAD","code_information":[{"code":"Px00040310005","type":"CDM"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":808.0,"discounted_cash":282.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":244.0,"discounted_cash":85.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC PET IMAGE W CT LIMITED","code_information":[{"code":"Px00040410009","type":"CDM"},{"code":"78814","type":"HCPCS"}],"standard_charges":[{"gross_charge":4896.0,"discounted_cash":1713.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PET IMAGE W CT SKULL MID THIGH","code_information":[{"code":"Px00040410010","type":"CDM"},{"code":"78815","type":"HCPCS"}],"standard_charges":[{"gross_charge":4896.0,"discounted_cash":1713.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PET IMAGE W CT WHOLE BODY","code_information":[{"code":"Px00040410011","type":"CDM"},{"code":"78816","type":"HCPCS"}],"standard_charges":[{"gross_charge":4896.0,"discounted_cash":1713.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTUBATION CDM","code_information":[{"code":"Px00041010003","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2079.0,"discounted_cash":727.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLOOD SAMPLING CAPILLARY CDM","code_information":[{"code":"Px00041010004","type":"CDM"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BLOOD DRAW ARTERIAL PUNCTURE CDM","code_information":[{"code":"Px00041010006","type":"CDM"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":64.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CARDIOPULMONARY RESUSCITATION CDM","code_information":[{"code":"Px00041010007","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.0,"discounted_cash":221.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":55.0,"discounted_cash":19.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PULSE OXIMETRY OVERNIGHT STUDY CDM","code_information":[{"code":"Px00041010013","type":"CDM"},{"code":"94762","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2500.0,"discounted_cash":875.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MECHANICAL CHEST WALL OSCILL CDM","code_information":[{"code":"Px00041010023","type":"CDM"},{"code":"94669","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.0,"discounted_cash":208.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":596.0,"discounted_cash":208.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":596.0,"discounted_cash":208.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MECHANICAL VENTILATION FIRST DAY CDM","code_information":[{"code":"Px00041010290","type":"CDM"},{"code":"94002","type":"HCPCS"}],"standard_charges":[{"gross_charge":6442.0,"discounted_cash":2254.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MECHANICAL VENTILATION SUBSEQUENT DAY CDM","code_information":[{"code":"Px00041010296","type":"CDM"},{"code":"94003","type":"HCPCS"}],"standard_charges":[{"gross_charge":6442.0,"discounted_cash":2254.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NONINVASIVE VENTILATION/CPAP DAILY CDM","code_information":[{"code":"Px00041010325","type":"CDM"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":3220.0,"discounted_cash":1127.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3220.0,"discounted_cash":1127.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":596.0,"discounted_cash":208.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":596.0,"discounted_cash":208.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CONGENITAL HEART DISEASE SCREEN PULSE OX MULT DET","code_information":[{"code":"Px00041010384","type":"CDM"}],"standard_charges":[{"gross_charge":747.0,"discounted_cash":261.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":599.0,"discounted_cash":209.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":754.0,"discounted_cash":263.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INHALATION TREATMENT DAILY","code_information":[{"code":"Px00041210006","type":"CDM"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":1103.0,"discounted_cash":386.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":186.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":186.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STRAPPING SHOULDER","code_information":[{"code":"Px00042010073","type":"CDM"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC APPLICATION RIGID TOTAL CONTACT LEG CAST","code_information":[{"code":"Px00042010075","type":"CDM"},{"code":"29445","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC STRAPPING UNNA BOOT","code_information":[{"code":"Px00042010080","type":"CDM"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CANALITH REPOSITIONING PROCEDURE - PER DAY","code_information":[{"code":"Px00042010108","type":"CDM"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":249.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS VASOPNEUMATIC DEVICES","code_information":[{"code":"Px00042010114","type":"CDM"},{"code":"97016","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INFRARED THERAPY","code_information":[{"code":"Px00042010121","type":"CDM"},{"code":"97026","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC AQUATIC THERAPY/EXERCISES - 15 MIN","code_information":[{"code":"Px00042010141","type":"CDM"},{"code":"97113","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":352.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC WHEELCHAIR MGMT EA 15 MIN","code_information":[{"code":"Px00042010165","type":"CDM"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":280.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":494.0,"discounted_cash":172.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":352.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":445.0,"discounted_cash":155.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":224.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":298.0,"discounted_cash":104.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":372.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":560.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":372.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":178.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":178.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":178.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":149.0,"discounted_cash":52.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":149.0,"discounted_cash":52.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":422.0,"discounted_cash":147.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":433.0,"discounted_cash":151.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":441.0,"discounted_cash":154.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":121.0,"discounted_cash":42.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":535.0,"discounted_cash":187.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":559.0,"discounted_cash":195.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":535.0,"discounted_cash":187.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":178.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":178.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":356.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":179.0,"discounted_cash":62.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1591.0,"discounted_cash":556.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":822.0,"discounted_cash":287.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PT EVALUATION LOW COMPLEX CDM","code_information":[{"code":"Px00042410066","type":"CDM"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PT EVALUATION  MOD COMPLEX CDM","code_information":[{"code":"Px00042410067","type":"CDM"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":189.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PT EVALUATION HIGH COMPLEX","code_information":[{"code":"Px00042410068","type":"CDM"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":551.0,"discounted_cash":192.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":151.0,"discounted_cash":52.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":753.0,"discounted_cash":263.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":389.0,"discounted_cash":136.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES","code_information":[{"code":"Px00043010007","type":"CDM"},{"code":"97533","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FINGER DYNAMIC SPLINT-APPL/FAB","code_information":[{"code":"Px00043010124","type":"CDM"},{"code":"29131","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1125.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":562.0,"discounted_cash":196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MC OT EVALUATION 30 MIN","code_information":[{"code":"Px00043410042","type":"CDM"},{"code":"X4100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2014.0,"discounted_cash":704.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1004.0,"discounted_cash":351.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OT EVALUATION LOW COMPLEX","code_information":[{"code":"Px00043410045","type":"CDM"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":234.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OT EVALUATION MOD COMPLEXITY","code_information":[{"code":"Px00043410046","type":"CDM"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":239.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OT EVALUATION HIGH COMPLEX","code_information":[{"code":"Px00043410047","type":"CDM"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":244.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":669.0,"discounted_cash":234.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":372.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":408.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ORAL FUNCTION THERAPY","code_information":[{"code":"Px00044010042","type":"CDM"},{"code":"92526","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ORAL SPEECH DEVICE EVAL","code_information":[{"code":"Px00044010050","type":"CDM"},{"code":"92597","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC USE OF SPEECH DEVICE SERVICE","code_information":[{"code":"Px00044010062","type":"CDM"},{"code":"92609","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ASSESSMENT OF APHASIA PER HOUR","code_information":[{"code":"Px00044010074","type":"CDM"},{"code":"96105","type":"HCPCS"}],"standard_charges":[{"gross_charge":3639.0,"discounted_cash":1273.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":728.0,"discounted_cash":254.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":700.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":465.0,"discounted_cash":162.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MC SPEECH LANGUAGE THERAPY 30MIN","code_information":[{"code":"Px00044010128","type":"CDM"},{"code":"X4304","type":"HCPCS"}],"standard_charges":[{"gross_charge":955.0,"discounted_cash":334.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MC SPEECH LANGUAGE THERAPY 60MIN","code_information":[{"code":"Px00044010129","type":"CDM"},{"code":"X4303","type":"HCPCS"}],"standard_charges":[{"gross_charge":1902.0,"discounted_cash":665.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MC SPEECH-LANG THER (GROUP) EACH PATIENT","code_information":[{"code":"Px00044300001","type":"CDM"},{"code":"X4302","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EX FOR SPEECH DEVICE RX 1HR","code_information":[{"code":"Px00044410022","type":"CDM"},{"code":"92607","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EX FOR SPEECH DEVICE RX EA ADDL 30 MIN","code_information":[{"code":"Px00044410025","type":"CDM"},{"code":"92608","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EVALUATE SWALLOWING FUNCTION","code_information":[{"code":"Px00044410026","type":"CDM"},{"code":"92610","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":254.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MOTION FLUOROSCOPY/SWALLOW","code_information":[{"code":"Px00044410043","type":"CDM"},{"code":"92611","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EVALUATION OF SPEECH FLUENCY","code_information":[{"code":"Px00044410063","type":"CDM"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":162.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":465.0,"discounted_cash":162.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MC LANGUAGE EVAL","code_information":[{"code":"Px00044410068","type":"CDM"},{"code":"X4300","type":"HCPCS"}],"standard_charges":[{"gross_charge":910.0,"discounted_cash":318.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MC SPEECH EVAL","code_information":[{"code":"Px00044410069","type":"CDM"},{"code":"X4301","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":211.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11230.0,"discounted_cash":3930.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3410.0,"discounted_cash":1193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":853.0,"discounted_cash":298.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3235.0,"discounted_cash":1132.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2170.0,"discounted_cash":759.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4540.0,"discounted_cash":1589.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5805.0,"discounted_cash":2031.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4202.0,"discounted_cash":1470.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1524.0,"discounted_cash":533.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9402.0,"discounted_cash":3290.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3410.0,"discounted_cash":1193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED TONSIL ASPIRATION CDM","code_information":[{"code":"Px00045000017","type":"CDM"},{"code":"45000017","type":"HCPCS"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":300.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":702.0,"discounted_cash":245.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3148.0,"discounted_cash":1101.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":691.0,"discounted_cash":241.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED J TUBE REPLACEMENT CDM","code_information":[{"code":"Px00045000024","type":"CDM"},{"code":"44799","type":"HCPCS"}],"standard_charges":[{"gross_charge":2464.0,"discounted_cash":862.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3148.0,"discounted_cash":1101.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":157.0,"discounted_cash":54.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3492.0,"discounted_cash":1222.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":627.0,"discounted_cash":219.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4886.0,"discounted_cash":1710.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1505.0,"discounted_cash":526.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3492.0,"discounted_cash":1222.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":627.0,"discounted_cash":219.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3492.0,"discounted_cash":1222.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":627.0,"discounted_cash":219.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1816.0,"discounted_cash":635.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1816.0,"discounted_cash":635.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":494.0,"discounted_cash":172.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4202.0,"discounted_cash":1470.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1816.0,"discounted_cash":635.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4002.0,"discounted_cash":1400.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":762.0,"discounted_cash":266.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4384.0,"discounted_cash":1534.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7222.0,"discounted_cash":2527.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1108.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":17570.0,"discounted_cash":6149.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":17570.0,"discounted_cash":6149.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12426.0,"discounted_cash":4349.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2076.0,"discounted_cash":726.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2076.0,"discounted_cash":726.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":275.0,"discounted_cash":96.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3445.0,"discounted_cash":1205.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4551.0,"discounted_cash":1592.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":485.0,"discounted_cash":169.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11394.0,"discounted_cash":3987.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10482.0,"discounted_cash":3668.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED VBAC DELIVERY ONLY CDM","code_information":[{"code":"Px00045000082","type":"CDM"},{"code":"59612","type":"HCPCS"}],"standard_charges":[{"gross_charge":5765.0,"discounted_cash":2017.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7767.0,"discounted_cash":2718.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED URETHRAL FB REMOVAL CDM","code_information":[{"code":"Px00045000084","type":"CDM"},{"code":"53899","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.0,"discounted_cash":227.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3105.0,"discounted_cash":1086.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":785.0,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2539.0,"discounted_cash":888.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3560.0,"discounted_cash":1246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5484.0,"discounted_cash":1919.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED THROMBOLYTIC VENOUS THERAPY CDM","code_information":[{"code":"Px00045000090","type":"CDM"},{"code":"37212","type":"HCPCS"}],"standard_charges":[{"gross_charge":16179.0,"discounted_cash":5662.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3388.0,"discounted_cash":1185.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4062.0,"discounted_cash":1421.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4062.0,"discounted_cash":1421.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":56.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":50.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED SUBCONJUNCTIVAL INJECTION CDM","code_information":[{"code":"Px00045000098","type":"CDM"},{"code":"68200","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3312.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3445.0,"discounted_cash":1205.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5765.0,"discounted_cash":2017.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":14651.0,"discounted_cash":5127.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3516.0,"discounted_cash":1230.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1743.0,"discounted_cash":610.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5534.0,"discounted_cash":1936.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1834.0,"discounted_cash":641.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":14593.0,"discounted_cash":5107.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US ED EXAM CHEST CDM","code_information":[{"code":"Px00045000136","type":"CDM"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1964.0,"discounted_cash":687.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2175.0,"discounted_cash":761.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2902.0,"discounted_cash":1015.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US ED ABDOMEN LIMITED CDM","code_information":[{"code":"Px00045000139","type":"CDM"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1754.0,"discounted_cash":613.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1208.0,"discounted_cash":422.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2413.0,"discounted_cash":844.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":540.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1390.0,"discounted_cash":486.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC US ED RETROPERITONEAL LIMITED CDM","code_information":[{"code":"Px00045000144","type":"CDM"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1625.0,"discounted_cash":568.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1811.0,"discounted_cash":633.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED ACNE SURGERY CDM","code_information":[{"code":"Px00045001301","type":"CDM"},{"code":"10040","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED CURETTAGE POSTPARTUM CDM","code_information":[{"code":"Px00045001309","type":"CDM"},{"code":"59160","type":"HCPCS"}],"standard_charges":[{"gross_charge":5765.0,"discounted_cash":2017.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":485.0,"discounted_cash":169.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11230.0,"discounted_cash":3930.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":8064.0,"discounted_cash":2822.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":8991.0,"discounted_cash":3146.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED INHALATION TREATMENT CDM","code_information":[{"code":"Px00045010003","type":"CDM"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":1103.0,"discounted_cash":386.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3312.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4459.0,"discounted_cash":1560.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7271.0,"discounted_cash":2544.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9089.0,"discounted_cash":3181.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4290.0,"discounted_cash":1501.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4290.0,"discounted_cash":1501.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":845.0,"discounted_cash":295.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1891.0,"discounted_cash":661.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1824.0,"discounted_cash":638.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1824.0,"discounted_cash":638.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12578.0,"discounted_cash":4402.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":13731.0,"discounted_cash":4805.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3918.0,"discounted_cash":1371.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1824.0,"discounted_cash":638.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":150.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED INDUCTION OF VOMITING CDM","code_information":[{"code":"Px00045010019","type":"CDM"},{"code":"99175","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":64.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":150.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4202.0,"discounted_cash":1470.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":909.0,"discounted_cash":318.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":277.0,"discounted_cash":96.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3312.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":543.0,"discounted_cash":190.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":662.0,"discounted_cash":231.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":732.0,"discounted_cash":256.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1708.0,"discounted_cash":597.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1776.0,"discounted_cash":621.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1848.0,"discounted_cash":646.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3445.0,"discounted_cash":1205.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5805.0,"discounted_cash":2031.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1524.0,"discounted_cash":533.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3445.0,"discounted_cash":1205.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6916.0,"discounted_cash":2420.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2438.0,"discounted_cash":853.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2076.0,"discounted_cash":726.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":812.0,"discounted_cash":284.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":489.0,"discounted_cash":171.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":522.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":489.0,"discounted_cash":171.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1436.0,"discounted_cash":502.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":974.0,"discounted_cash":340.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6724.0,"discounted_cash":2353.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":14651.0,"discounted_cash":5127.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":14651.0,"discounted_cash":5127.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":275.0,"discounted_cash":96.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3410.0,"discounted_cash":1193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3410.0,"discounted_cash":1193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9045.0,"discounted_cash":3165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING HIP CDM","code_information":[{"code":"Px00045010065","type":"CDM"},{"code":"29520","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2079.0,"discounted_cash":727.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":904.0,"discounted_cash":316.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1657.0,"discounted_cash":579.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":22350.0,"discounted_cash":7822.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1488.0,"discounted_cash":520.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":275.0,"discounted_cash":96.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4052.0,"discounted_cash":1418.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4980.0,"discounted_cash":1743.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7851.0,"discounted_cash":2747.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3858.0,"discounted_cash":1350.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4422.0,"discounted_cash":1547.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":714.0,"discounted_cash":249.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":891.0,"discounted_cash":311.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":185.0,"discounted_cash":64.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":762.0,"discounted_cash":266.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3312.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4202.0,"discounted_cash":1470.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1516.0,"discounted_cash":530.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7851.0,"discounted_cash":2747.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1516.0,"discounted_cash":530.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":543.0,"discounted_cash":190.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":973.0,"discounted_cash":340.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2220.0,"discounted_cash":777.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7433.0,"discounted_cash":2601.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2531.0,"discounted_cash":885.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2844.0,"discounted_cash":995.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED PROCTOSIGMOIDOSCOPY DX CDM","code_information":[{"code":"Px00045010098","type":"CDM"},{"code":"45300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1776.0,"discounted_cash":621.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED PROCTOSIGMOIDOSCOPY FB CDM","code_information":[{"code":"Px00045010099","type":"CDM"},{"code":"45307","type":"HCPCS"}],"standard_charges":[{"gross_charge":3225.0,"discounted_cash":1128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2177.0,"discounted_cash":761.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1937.0,"discounted_cash":677.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2531.0,"discounted_cash":885.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4370.0,"discounted_cash":1529.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6536.0,"discounted_cash":2287.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1628.0,"discounted_cash":569.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7734.0,"discounted_cash":2706.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1040.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1185.0,"discounted_cash":414.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3410.0,"discounted_cash":1193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":228.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":286.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED NASOPHARYNGOSCOPY CDM","code_information":[{"code":"Px00045010113","type":"CDM"},{"code":"92511","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":131.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF MISCARRIAGE CDM","code_information":[{"code":"Px00045010115","type":"CDM"},{"code":"59812","type":"HCPCS"}],"standard_charges":[{"gross_charge":3560.0,"discounted_cash":1246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9988.0,"discounted_cash":3495.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED VAGINAL DELIVERY ONLY CDM","code_information":[{"code":"Px00045010118","type":"CDM"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":5765.0,"discounted_cash":2017.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED DELIVER PLACENTA CDM","code_information":[{"code":"Px00045010119","type":"CDM"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":3560.0,"discounted_cash":1246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED SPONTANEOUS ABORTION FAC CDM","code_information":[{"code":"Px00045010121","type":"CDM"},{"code":"59820","type":"HCPCS"}],"standard_charges":[{"gross_charge":3560.0,"discounted_cash":1246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":740.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1943.0,"discounted_cash":680.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3235.0,"discounted_cash":1132.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED DISTAL RADIAL FRACTURE CDM","code_information":[{"code":"Px00045010138","type":"CDM"},{"code":"25606","type":"HCPCS"}],"standard_charges":[{"gross_charge":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":221.0,"discounted_cash":77.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":221.0,"discounted_cash":77.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":221.0,"discounted_cash":77.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2605.0,"discounted_cash":911.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":485.0,"discounted_cash":169.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":479.0,"discounted_cash":167.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3410.0,"discounted_cash":1193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT KNEE DISLOCATION CDM","code_information":[{"code":"Px00045010159","type":"CDM"},{"code":"27550","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7311.0,"discounted_cash":2558.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":543.0,"discounted_cash":190.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5805.0,"discounted_cash":2031.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11230.0,"discounted_cash":3930.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR ACHILLES TENDON CDM","code_information":[{"code":"Px00045010173","type":"CDM"},{"code":"27650","type":"HCPCS"}],"standard_charges":[{"gross_charge":14651.0,"discounted_cash":5127.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9045.0,"discounted_cash":3165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":655.0,"discounted_cash":229.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7101.0,"discounted_cash":2485.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9045.0,"discounted_cash":3165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11196.0,"discounted_cash":3918.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9045.0,"discounted_cash":3165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7101.0,"discounted_cash":2485.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3666.0,"discounted_cash":1283.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":670.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1123.0,"discounted_cash":393.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2239.0,"discounted_cash":783.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3758.0,"discounted_cash":1315.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5364.0,"discounted_cash":1877.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":489.0,"discounted_cash":171.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2570.0,"discounted_cash":899.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":927.0,"discounted_cash":324.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2268.0,"discounted_cash":793.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":277.0,"discounted_cash":96.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOURETHROSCOPY CDM","code_information":[{"code":"Px00045010230","type":"CDM"},{"code":"52000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2018.0,"discounted_cash":706.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7767.0,"discounted_cash":2718.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9045.0,"discounted_cash":3165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5785.0,"discounted_cash":2024.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11230.0,"discounted_cash":3930.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":522.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7767.0,"discounted_cash":2718.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":495.0,"discounted_cash":173.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6916.0,"discounted_cash":2420.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4202.0,"discounted_cash":1470.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":534.0,"discounted_cash":186.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":534.0,"discounted_cash":186.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7767.0,"discounted_cash":2718.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":649.0,"discounted_cash":227.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7767.0,"discounted_cash":2718.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11230.0,"discounted_cash":3930.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":649.0,"discounted_cash":227.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3410.0,"discounted_cash":1193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7311.0,"discounted_cash":2558.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":655.0,"discounted_cash":229.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5805.0,"discounted_cash":2031.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5524.0,"discounted_cash":1933.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11230.0,"discounted_cash":3930.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":690.0,"discounted_cash":241.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12426.0,"discounted_cash":4349.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6503.0,"discounted_cash":2276.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10482.0,"discounted_cash":3668.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9045.0,"discounted_cash":3165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":649.0,"discounted_cash":227.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6435.0,"discounted_cash":2252.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5524.0,"discounted_cash":1933.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7767.0,"discounted_cash":2718.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2263.0,"discounted_cash":792.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED PLACEMENT SETON CDM","code_information":[{"code":"Px00045010301","type":"CDM"},{"code":"46020","type":"HCPCS"}],"standard_charges":[{"gross_charge":3235.0,"discounted_cash":1132.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12426.0,"discounted_cash":4349.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4698.0,"discounted_cash":1644.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1930.0,"discounted_cash":675.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1930.0,"discounted_cash":675.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6916.0,"discounted_cash":2420.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5490.0,"discounted_cash":1921.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":890.0,"discounted_cash":311.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1708.0,"discounted_cash":597.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1708.0,"discounted_cash":597.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":787.0,"discounted_cash":275.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3860.0,"discounted_cash":1351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12578.0,"discounted_cash":4402.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3860.0,"discounted_cash":1351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6503.0,"discounted_cash":2276.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDE INFECTED SKIN CDM","code_information":[{"code":"Px00045010318","type":"CDM"},{"code":"11000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1437.0,"discounted_cash":502.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":313.0,"discounted_cash":109.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1708.0,"discounted_cash":597.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6503.0,"discounted_cash":2276.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":840.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":871.0,"discounted_cash":304.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6805.0,"discounted_cash":2381.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2545.0,"discounted_cash":890.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4202.0,"discounted_cash":1470.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":494.0,"discounted_cash":172.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":221.0,"discounted_cash":77.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":847.0,"discounted_cash":296.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1741.0,"discounted_cash":609.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3445.0,"discounted_cash":1205.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1848.0,"discounted_cash":646.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1885.0,"discounted_cash":659.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1922.0,"discounted_cash":672.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3445.0,"discounted_cash":1205.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3445.0,"discounted_cash":1205.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1437.0,"discounted_cash":502.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":457.0,"discounted_cash":159.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":467.0,"discounted_cash":163.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":973.0,"discounted_cash":340.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9402.0,"discounted_cash":3290.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":973.0,"discounted_cash":340.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":973.0,"discounted_cash":340.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1437.0,"discounted_cash":502.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1437.0,"discounted_cash":502.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4698.0,"discounted_cash":1644.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":485.0,"discounted_cash":169.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1437.0,"discounted_cash":502.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1437.0,"discounted_cash":502.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1437.0,"discounted_cash":502.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4270.0,"discounted_cash":1494.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":968.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":987.0,"discounted_cash":345.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1007.0,"discounted_cash":352.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1027.0,"discounted_cash":359.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1047.0,"discounted_cash":366.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1250.0,"discounted_cash":437.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1282.0,"discounted_cash":448.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1437.0,"discounted_cash":502.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":263.0,"discounted_cash":92.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1437.0,"discounted_cash":502.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1437.0,"discounted_cash":502.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3410.0,"discounted_cash":1193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":228.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4290.0,"discounted_cash":1501.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2844.0,"discounted_cash":995.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2844.0,"discounted_cash":995.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2177.0,"discounted_cash":761.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED INCISE EXTERNAL HEMORRHOID CDM","code_information":[{"code":"Px00045010410","type":"CDM"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6701.0,"discounted_cash":2345.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2844.0,"discounted_cash":995.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC ANOSCOPY CDM","code_information":[{"code":"Px00045010414","type":"CDM"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2564.0,"discounted_cash":897.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED ANOSCOPY CONTROL BLEEDING CDM","code_information":[{"code":"Px00045010416","type":"CDM"},{"code":"46614","type":"HCPCS"}],"standard_charges":[{"gross_charge":2531.0,"discounted_cash":885.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3235.0,"discounted_cash":1132.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7101.0,"discounted_cash":2485.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1177.0,"discounted_cash":411.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED REV EYELID LAT CDM","code_information":[{"code":"Px00045010422","type":"CDM"},{"code":"21282","type":"HCPCS"}],"standard_charges":[{"gross_charge":6805.0,"discounted_cash":2381.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED IRRIGATION OF BLADDER CDM","code_information":[{"code":"Px00045010423","type":"CDM"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":543.0,"discounted_cash":190.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3312.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4370.0,"discounted_cash":1529.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF URETHRA CDM","code_information":[{"code":"Px00045010427","type":"CDM"},{"code":"53020","type":"HCPCS"}],"standard_charges":[{"gross_charge":4384.0,"discounted_cash":1534.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4384.0,"discounted_cash":1534.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6805.0,"discounted_cash":2381.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2025.0,"discounted_cash":708.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":485.0,"discounted_cash":169.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4912.0,"discounted_cash":1719.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED PREPUTIAL STRETCHING CDM","code_information":[{"code":"Px00045010434","type":"CDM"},{"code":"54450","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED REDUCE TESTIS TORSION CDM","code_information":[{"code":"Px00045010435","type":"CDM"},{"code":"54600","type":"HCPCS"}],"standard_charges":[{"gross_charge":6536.0,"discounted_cash":2287.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF SCROTUM CDM","code_information":[{"code":"Px00045010436","type":"CDM"},{"code":"54700","type":"HCPCS"}],"standard_charges":[{"gross_charge":4912.0,"discounted_cash":1719.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3860.0,"discounted_cash":1351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4384.0,"discounted_cash":1534.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":775.0,"discounted_cash":271.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3560.0,"discounted_cash":1246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5836.0,"discounted_cash":2042.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT VAGINAL BLEEDING CDM","code_information":[{"code":"Px00045010444","type":"CDM"},{"code":"57180","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5765.0,"discounted_cash":2017.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR VAGINA/PERINEUM CDM","code_information":[{"code":"Px00045010446","type":"CDM"},{"code":"57210","type":"HCPCS"}],"standard_charges":[{"gross_charge":5765.0,"discounted_cash":2017.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED PELVIC EXAMINATION CDM","code_information":[{"code":"Px00045010447","type":"CDM"},{"code":"57410","type":"HCPCS"}],"standard_charges":[{"gross_charge":3560.0,"discounted_cash":1246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5765.0,"discounted_cash":2017.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":485.0,"discounted_cash":169.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED BIOPSY OF CERVIX CDM","code_information":[{"code":"Px00045010451","type":"CDM"},{"code":"57500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1739.0,"discounted_cash":608.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED CAUTERIZATION OF CERVIX CDM","code_information":[{"code":"Px00045010452","type":"CDM"},{"code":"57510","type":"HCPCS"}],"standard_charges":[{"gross_charge":3560.0,"discounted_cash":1246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3410.0,"discounted_cash":1193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED DILATION AND CURETTAGE CDM","code_information":[{"code":"Px00045010454","type":"CDM"},{"code":"58120","type":"HCPCS"}],"standard_charges":[{"gross_charge":3560.0,"discounted_cash":1246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE INTRAUTERINE DEVICE CDM","code_information":[{"code":"Px00045010455","type":"CDM"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":890.0,"discounted_cash":311.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6785.0,"discounted_cash":2374.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6785.0,"discounted_cash":2374.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6785.0,"discounted_cash":2374.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":522.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":522.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1628.0,"discounted_cash":569.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3410.0,"discounted_cash":1193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3445.0,"discounted_cash":1205.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":522.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2263.0,"discounted_cash":792.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":444.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT 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":844.0,"discounted_cash":295.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6215.0,"discounted_cash":2175.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED CURETTE/TREAT CORNEA CDM","code_information":[{"code":"Px00045010475","type":"CDM"},{"code":"65435","type":"HCPCS"}],"standard_charges":[{"gross_charge":1369.0,"discounted_cash":479.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4781.0,"discounted_cash":1673.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED REVISION OF CORNEA CDM","code_information":[{"code":"Px00045010479","type":"CDM"},{"code":"65600","type":"HCPCS"}],"standard_charges":[{"gross_charge":4781.0,"discounted_cash":1673.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5484.0,"discounted_cash":1919.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6215.0,"discounted_cash":2175.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":812.0,"discounted_cash":284.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1708.0,"discounted_cash":597.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3860.0,"discounted_cash":1351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":277.0,"discounted_cash":96.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":277.0,"discounted_cash":96.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED PERCUTANEOUS FIXATION FEMORAL CDM","code_information":[{"code":"Px00045010493","type":"CDM"},{"code":"27509","type":"HCPCS"}],"standard_charges":[{"gross_charge":14651.0,"discounted_cash":5127.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7311.0,"discounted_cash":2558.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1437.0,"discounted_cash":502.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":277.0,"discounted_cash":96.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1437.0,"discounted_cash":502.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1437.0,"discounted_cash":502.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4270.0,"discounted_cash":1494.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":762.0,"discounted_cash":266.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":8991.0,"discounted_cash":3146.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":8991.0,"discounted_cash":3146.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4270.0,"discounted_cash":1494.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1282.0,"discounted_cash":448.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":18485.0,"discounted_cash":6469.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":8991.0,"discounted_cash":3146.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":8991.0,"discounted_cash":3146.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12578.0,"discounted_cash":4402.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5805.0,"discounted_cash":2031.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":457.0,"discounted_cash":159.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1776.0,"discounted_cash":621.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":847.0,"discounted_cash":296.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1282.0,"discounted_cash":448.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED CHEMICAL CAUTERY TISSUE CDM","code_information":[{"code":"Px00045010525","type":"CDM"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3860.0,"discounted_cash":1351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND NECK CDM","code_information":[{"code":"Px00045010530","type":"CDM"},{"code":"20100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1108.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND CHEST CDM","code_information":[{"code":"Px00045010531","type":"CDM"},{"code":"20101","type":"HCPCS"}],"standard_charges":[{"gross_charge":4698.0,"discounted_cash":1644.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND ABDOMEN CDM","code_information":[{"code":"Px00045010532","type":"CDM"},{"code":"20102","type":"HCPCS"}],"standard_charges":[{"gross_charge":4698.0,"discounted_cash":1644.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND EXTREMITY CDM","code_information":[{"code":"Px00045010533","type":"CDM"},{"code":"20103","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":597.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3860.0,"discounted_cash":1351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5525.0,"discounted_cash":1933.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":522.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1642.0,"discounted_cash":574.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1104.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1127.0,"discounted_cash":394.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3410.0,"discounted_cash":1193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5524.0,"discounted_cash":1933.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3445.0,"discounted_cash":1205.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED FLUID PRESSURE MUSCLE CDM","code_information":[{"code":"Px00045010544","type":"CDM"},{"code":"20950","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":597.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3445.0,"discounted_cash":1205.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7503.0,"discounted_cash":2626.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4202.0,"discounted_cash":1470.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11230.0,"discounted_cash":3930.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1108.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":8846.0,"discounted_cash":3096.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10891.0,"discounted_cash":3811.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1108.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3312.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6503.0,"discounted_cash":2276.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT STERNUM FRACTURE CDM","code_information":[{"code":"Px00045010560","type":"CDM"},{"code":"21820","type":"HCPCS"}],"standard_charges":[{"gross_charge":1034.0,"discounted_cash":361.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SPINE FRACTURE CDM","code_information":[{"code":"Px00045010562","type":"CDM"},{"code":"22310","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.0,"discounted_cash":227.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN SHOULDER LESION CDM","code_information":[{"code":"Px00045010563","type":"CDM"},{"code":"23030","type":"HCPCS"}],"standard_charges":[{"gross_charge":5805.0,"discounted_cash":2031.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1708.0,"discounted_cash":597.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":479.0,"discounted_cash":167.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3410.0,"discounted_cash":1193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":543.0,"discounted_cash":190.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":354.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3410.0,"discounted_cash":1193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED SHOULDER SURGERY PROCEDURE CDM","code_information":[{"code":"Px00045010601","type":"CDM"},{"code":"23929","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.0,"discounted_cash":227.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5805.0,"discounted_cash":2031.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7388.0,"discounted_cash":2585.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3860.0,"discounted_cash":1351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7028.0,"discounted_cash":2459.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":354.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3710.0,"discounted_cash":1298.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1628.0,"discounted_cash":569.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1524.0,"discounted_cash":533.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5805.0,"discounted_cash":2031.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11230.0,"discounted_cash":3930.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT KNUCKLE DISLOCATION CDM","code_information":[{"code":"Px00045010621","type":"CDM"},{"code":"26705","type":"HCPCS"}],"standard_charges":[{"gross_charge":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":8064.0,"discounted_cash":2822.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR EYELID WOUND CDM","code_information":[{"code":"Px00045010627","type":"CDM"},{"code":"67930","type":"HCPCS"}],"standard_charges":[{"gross_charge":4781.0,"discounted_cash":1673.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3024.0,"discounted_cash":1058.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1816.0,"discounted_cash":635.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE CDM","code_information":[{"code":"Px00045010632","type":"CDM"},{"code":"23615","type":"HCPCS"}],"standard_charges":[{"gross_charge":26611.0,"discounted_cash":9313.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ELBOW FRACTURE CDM","code_information":[{"code":"Px00045010633","type":"CDM"},{"code":"24635","type":"HCPCS"}],"standard_charges":[{"gross_charge":14651.0,"discounted_cash":5127.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9045.0,"discounted_cash":3165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9045.0,"discounted_cash":3165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED HAND TENDON RECONSTRUCTION CDM","code_information":[{"code":"Px00045010637","type":"CDM"},{"code":"26502","type":"HCPCS"}],"standard_charges":[{"gross_charge":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9045.0,"discounted_cash":3165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":14651.0,"discounted_cash":5127.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":14651.0,"discounted_cash":5127.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED CORRECTION OF BUNION CDM","code_information":[{"code":"Px00045010641","type":"CDM"},{"code":"28296","type":"HCPCS"}],"standard_charges":[{"gross_charge":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED CONTROL THROAT BLEEDING CDM","code_information":[{"code":"Px00045010642","type":"CDM"},{"code":"42962","type":"HCPCS"}],"standard_charges":[{"gross_charge":9399.0,"discounted_cash":3289.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3235.0,"discounted_cash":1132.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED HEMORRHOIDOPEXY BY STAPLING CDM","code_information":[{"code":"Px00045010645","type":"CDM"},{"code":"46947","type":"HCPCS"}],"standard_charges":[{"gross_charge":3235.0,"discounted_cash":1132.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED LAPARO CHOLECYSTECTOMY/GRAPH CDM","code_information":[{"code":"Px00045010647","type":"CDM"},{"code":"47563","type":"HCPCS"}],"standard_charges":[{"gross_charge":10629.0,"discounted_cash":3720.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4022.0,"discounted_cash":1407.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOSCOPY AND TREATMENT CDM","code_information":[{"code":"Px00045010649","type":"CDM"},{"code":"52214","type":"HCPCS"}],"standard_charges":[{"gross_charge":4022.0,"discounted_cash":1407.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3560.0,"discounted_cash":1246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5805.0,"discounted_cash":2031.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4202.0,"discounted_cash":1470.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4270.0,"discounted_cash":1494.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12600.0,"discounted_cash":4410.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3388.0,"discounted_cash":1185.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF EYE CDM","code_information":[{"code":"Px00045010663","type":"CDM"},{"code":"65800","type":"HCPCS"}],"standard_charges":[{"gross_charge":3388.0,"discounted_cash":1185.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":228.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED HYMENOTOMY SIMPLE INCISION CDM","code_information":[{"code":"Px00045010665","type":"CDM"},{"code":"56442","type":"HCPCS"}],"standard_charges":[{"gross_charge":5765.0,"discounted_cash":2017.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4270.0,"discounted_cash":1494.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3235.0,"discounted_cash":1132.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":14651.0,"discounted_cash":5127.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5364.0,"discounted_cash":1877.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11230.0,"discounted_cash":3930.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2585.0,"discounted_cash":904.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9045.0,"discounted_cash":3165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED REPLANTATION DIGIT COMPLETE CDM","code_information":[{"code":"Px00045010675","type":"CDM"},{"code":"20822","type":"HCPCS"}],"standard_charges":[{"gross_charge":5524.0,"discounted_cash":1933.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED HYPOTHERMIA ILL NEONATE CDM","code_information":[{"code":"Px00045010676","type":"CDM"},{"code":"99184","type":"HCPCS"}],"standard_charges":[{"gross_charge":4800.0,"discounted_cash":1680.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4781.0,"discounted_cash":1673.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":277.0,"discounted_cash":96.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":514.0,"discounted_cash":179.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11230.0,"discounted_cash":3930.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1108.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3718.0,"discounted_cash":1301.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED ESCHAROTOMY ADDL INCISION CDM","code_information":[{"code":"Px00045010684","type":"CDM"},{"code":"16036","type":"HCPCS"}],"standard_charges":[{"gross_charge":4194.0,"discounted_cash":1467.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE/REPAIR CHEST CDM","code_information":[{"code":"Px00045010685","type":"CDM"},{"code":"32110","type":"HCPCS"}],"standard_charges":[{"gross_charge":10482.0,"discounted_cash":3668.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1369.0,"discounted_cash":479.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6840.0,"discounted_cash":2394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3410.0,"discounted_cash":1193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11230.0,"discounted_cash":3930.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR PALATE CDM","code_information":[{"code":"Px00045010690","type":"CDM"},{"code":"42182","type":"HCPCS"}],"standard_charges":[{"gross_charge":6724.0,"discounted_cash":2353.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED REVISE FINGER JOINT CDM","code_information":[{"code":"Px00045010691","type":"CDM"},{"code":"26535","type":"HCPCS"}],"standard_charges":[{"gross_charge":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11230.0,"discounted_cash":3930.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11230.0,"discounted_cash":3930.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3560.0,"discounted_cash":1246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":8991.0,"discounted_cash":3146.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1437.0,"discounted_cash":502.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":314.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1524.0,"discounted_cash":533.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1524.0,"discounted_cash":533.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1260.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5805.0,"discounted_cash":2031.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11230.0,"discounted_cash":3930.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9045.0,"discounted_cash":3165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING UNNA BOOT CDM","code_information":[{"code":"Px00045010706","type":"CDM"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":19208.0,"discounted_cash":6722.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE CDM","code_information":[{"code":"Px00045010713","type":"CDM"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.0,"discounted_cash":190.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":438.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":290.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2268.0,"discounted_cash":793.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5490.0,"discounted_cash":1921.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED PERCUTANEOUS FIXATION HUMERAL CDM","code_information":[{"code":"Px00045010721","type":"CDM"},{"code":"24538","type":"HCPCS"}],"standard_charges":[{"gross_charge":9045.0,"discounted_cash":3165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1657.0,"discounted_cash":579.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3858.0,"discounted_cash":1350.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1241.0,"discounted_cash":434.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM","code_information":[{"code":"Px00045010728","type":"CDM"},{"code":"43235","type":"HCPCS"}],"standard_charges":[{"gross_charge":1516.0,"discounted_cash":530.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6437.0,"discounted_cash":2252.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2220.0,"discounted_cash":777.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION CHALAZION SINGLE CDM","code_information":[{"code":"Px00045010737","type":"CDM"},{"code":"67800","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":828.0,"discounted_cash":289.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":122.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9045.0,"discounted_cash":3165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":26611.0,"discounted_cash":9313.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3410.0,"discounted_cash":1193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":14651.0,"discounted_cash":5127.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT RADIUS FRACTURE CDM","code_information":[{"code":"Px00045010752","type":"CDM"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":26611.0,"discounted_cash":9313.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":26611.0,"discounted_cash":9313.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":14651.0,"discounted_cash":5127.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5765.0,"discounted_cash":2017.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ULNAR FRACTURE CDM","code_information":[{"code":"Px00045010760","type":"CDM"},{"code":"24670","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":828.0,"discounted_cash":289.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":442.0,"discounted_cash":154.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED FETAL NONSTRESS TEST CDM","code_information":[{"code":"Px00045010765","type":"CDM"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":142.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":588.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6041.0,"discounted_cash":2114.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":992.0,"discounted_cash":347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7767.0,"discounted_cash":2718.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":890.0,"discounted_cash":311.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":451.0,"discounted_cash":157.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2464.0,"discounted_cash":862.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5414.0,"discounted_cash":1894.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":560.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7616.0,"discounted_cash":2665.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5524.0,"discounted_cash":1933.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2131.0,"discounted_cash":745.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6622.0,"discounted_cash":2317.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6787.0,"discounted_cash":2375.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2546.0,"discounted_cash":891.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":14651.0,"discounted_cash":5127.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9045.0,"discounted_cash":3165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11230.0,"discounted_cash":3930.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3445.0,"discounted_cash":1205.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5805.0,"discounted_cash":2031.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2846.0,"discounted_cash":996.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED PERQ CERVICOTHORACIC INJECT CDM","code_information":[{"code":"Px00045010809","type":"CDM"},{"code":"22510","type":"HCPCS"}],"standard_charges":[{"gross_charge":16430.0,"discounted_cash":5750.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED PERQ LUMBOSACRAL INJECTION CDM","code_information":[{"code":"Px00045010811","type":"CDM"},{"code":"22511","type":"HCPCS"}],"standard_charges":[{"gross_charge":16430.0,"discounted_cash":5750.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":26611.0,"discounted_cash":9313.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3445.0,"discounted_cash":1205.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11230.0,"discounted_cash":3930.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3410.0,"discounted_cash":1193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11230.0,"discounted_cash":3930.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":407.0,"discounted_cash":142.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING SHOULDER CDM","code_information":[{"code":"Px00045010831","type":"CDM"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":313.0,"discounted_cash":109.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":313.0,"discounted_cash":109.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":543.0,"discounted_cash":190.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3402.0,"discounted_cash":1190.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":668.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4178.0,"discounted_cash":1462.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7767.0,"discounted_cash":2718.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7767.0,"discounted_cash":2718.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":543.0,"discounted_cash":190.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":758.0,"discounted_cash":265.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4290.0,"discounted_cash":1501.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5805.0,"discounted_cash":2031.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3312.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4202.0,"discounted_cash":1470.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3860.0,"discounted_cash":1351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2220.0,"discounted_cash":777.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4912.0,"discounted_cash":1719.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1628.0,"discounted_cash":569.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":8064.0,"discounted_cash":2822.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":75.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":8064.0,"discounted_cash":2822.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4412.0,"discounted_cash":1544.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1436.0,"discounted_cash":502.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3410.0,"discounted_cash":1193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED BX INTRANASAL MUCOSA CDM","code_information":[{"code":"Px00045010878","type":"CDM"},{"code":"30100","type":"HCPCS"}],"standard_charges":[{"gross_charge":3312.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3312.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3718.0,"discounted_cash":1301.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3718.0,"discounted_cash":1301.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4833.0,"discounted_cash":1691.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":13896.0,"discounted_cash":4863.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":8064.0,"discounted_cash":2822.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":15684.0,"discounted_cash":5489.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3410.0,"discounted_cash":1193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":18774.0,"discounted_cash":6570.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3644.0,"discounted_cash":1275.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3443.0,"discounted_cash":1205.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":17760.0,"discounted_cash":6216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7774.0,"discounted_cash":2720.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3445.0,"discounted_cash":1205.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3312.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3105.0,"discounted_cash":1086.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":508.0,"discounted_cash":177.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7767.0,"discounted_cash":2718.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED PRESSURE TREATMENT ESOPHAGUS CDM","code_information":[{"code":"Px00045010902","type":"CDM"},{"code":"43460","type":"HCPCS"}],"standard_charges":[{"gross_charge":10482.0,"discounted_cash":3668.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2539.0,"discounted_cash":888.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1937.0,"discounted_cash":677.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3235.0,"discounted_cash":1132.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED REP PERINEAL APRCH CDM","code_information":[{"code":"Px00045010912","type":"CDM"},{"code":"45541","type":"HCPCS"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3235.0,"discounted_cash":1132.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1943.0,"discounted_cash":680.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":847.0,"discounted_cash":296.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7222.0,"discounted_cash":2527.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":21281.0,"discounted_cash":7448.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4022.0,"discounted_cash":1407.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4022.0,"discounted_cash":1407.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3445.0,"discounted_cash":1205.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED ORCHIOPEXY INGUINAL CDM","code_information":[{"code":"Px00045010927","type":"CDM"},{"code":"54640","type":"HCPCS"}],"standard_charges":[{"gross_charge":7222.0,"discounted_cash":2527.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED COLPOSCOPY VULVA CDM","code_information":[{"code":"Px00045010928","type":"CDM"},{"code":"56820","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":479.0,"discounted_cash":167.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":159.0,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":280.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED COLPOTOMY WITH EXPLORATION CDM","code_information":[{"code":"Px00045010933","type":"CDM"},{"code":"57000","type":"HCPCS"}],"standard_charges":[{"gross_charge":5765.0,"discounted_cash":2017.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5765.0,"discounted_cash":2017.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5805.0,"discounted_cash":2031.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED CAUTERIZATION CHEMICAL CERVIX CDM","code_information":[{"code":"Px00045010936","type":"CDM"},{"code":"58999","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.0,"discounted_cash":227.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":942.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9181.0,"discounted_cash":3213.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3560.0,"discounted_cash":1246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":479.0,"discounted_cash":167.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":479.0,"discounted_cash":167.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10205.0,"discounted_cash":3571.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3614.0,"discounted_cash":1264.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2585.0,"discounted_cash":904.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3747.0,"discounted_cash":1311.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1816.0,"discounted_cash":635.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":760.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":426.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1816.0,"discounted_cash":635.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1816.0,"discounted_cash":635.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4858.0,"discounted_cash":1700.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3388.0,"discounted_cash":1185.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED RECON EYELID CDM","code_information":[{"code":"Px00045010959","type":"CDM"},{"code":"67950","type":"HCPCS"}],"standard_charges":[{"gross_charge":4781.0,"discounted_cash":1673.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":562.0,"discounted_cash":196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":681.0,"discounted_cash":238.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED VENOUS PRESSURE DETERMINATION CDM","code_information":[{"code":"Px00045010964","type":"CDM"},{"code":"93770","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":158.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":399.0,"discounted_cash":139.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":904.0,"discounted_cash":316.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1076.0,"discounted_cash":376.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":220.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":159.0,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1182.0,"discounted_cash":413.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":182.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1587.0,"discounted_cash":555.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":182.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1076.0,"discounted_cash":376.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":220.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":205.0,"discounted_cash":71.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1076.0,"discounted_cash":376.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":650.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12426.0,"discounted_cash":4349.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1524.0,"discounted_cash":533.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":485.0,"discounted_cash":169.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6806.0,"discounted_cash":2382.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1480.0,"discounted_cash":518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1099.0,"discounted_cash":384.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":541.0,"discounted_cash":189.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":655.0,"discounted_cash":229.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":14651.0,"discounted_cash":5127.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1708.0,"discounted_cash":597.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3860.0,"discounted_cash":1351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3860.0,"discounted_cash":1351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":543.0,"discounted_cash":190.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3410.0,"discounted_cash":1193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7767.0,"discounted_cash":2718.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":489.0,"discounted_cash":171.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FOOT DISLOCATION CDM","code_information":[{"code":"Px00045013082","type":"CDM"},{"code":"28570","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6933.0,"discounted_cash":2426.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3820.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":543.0,"discounted_cash":190.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED APPLY FINGER CAST CDM","code_information":[{"code":"Px00045013105","type":"CDM"},{"code":"29086","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED CYLINDER CAST APPLICATION CDM","code_information":[{"code":"Px00045013122","type":"CDM"},{"code":"29365","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF KNEE CDM","code_information":[{"code":"Px00045013135","type":"CDM"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF TOES CDM","code_information":[{"code":"Px00045013139","type":"CDM"},{"code":"29550","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED WINDOWING OF CAST CDM","code_information":[{"code":"Px00045013151","type":"CDM"},{"code":"29730","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":865.0,"discounted_cash":302.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1708.0,"discounted_cash":597.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1708.0,"discounted_cash":597.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED NASAL ENDOSCOPY DX CDM","code_information":[{"code":"Px00045013187","type":"CDM"},{"code":"31231","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":131.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4833.0,"discounted_cash":1691.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7765.0,"discounted_cash":2717.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC LARYNGOSCOPY INDIRECT CDM","code_information":[{"code":"Px00045013192","type":"CDM"},{"code":"31505","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":422.0,"discounted_cash":147.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED DX LARYNGOSCOPY NEWBORN CDM","code_information":[{"code":"Px00045013194","type":"CDM"},{"code":"31520","type":"HCPCS"}],"standard_charges":[{"gross_charge":992.0,"discounted_cash":347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4833.0,"discounted_cash":1691.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4833.0,"discounted_cash":1691.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC LARYNGOSCOPY CDM","code_information":[{"code":"Px00045013197","type":"CDM"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED LARYNGOSCOPY WITH BIOPSY CDM","code_information":[{"code":"Px00045013198","type":"CDM"},{"code":"31576","type":"HCPCS"}],"standard_charges":[{"gross_charge":3718.0,"discounted_cash":1301.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1290.0,"discounted_cash":451.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4678.0,"discounted_cash":1637.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED TRACHEOSTOMY CDM","code_information":[{"code":"Px00045013201","type":"CDM"},{"code":"31603","type":"HCPCS"}],"standard_charges":[{"gross_charge":7102.0,"discounted_cash":2485.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED CRICOTHYROIDOTOMY CDM","code_information":[{"code":"Px00045013202","type":"CDM"},{"code":"31605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2478.0,"discounted_cash":867.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED VISUALIZATION OF WINDPIPE CDM","code_information":[{"code":"Px00045013203","type":"CDM"},{"code":"31615","type":"HCPCS"}],"standard_charges":[{"gross_charge":1104.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10482.0,"discounted_cash":3668.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10482.0,"discounted_cash":3668.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":8064.0,"discounted_cash":2822.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6840.0,"discounted_cash":2394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6840.0,"discounted_cash":2394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1241.0,"discounted_cash":434.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1108.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3710.0,"discounted_cash":1298.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1108.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1108.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2220.0,"discounted_cash":777.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":543.0,"discounted_cash":190.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1241.0,"discounted_cash":434.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1108.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":485.0,"discounted_cash":169.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":485.0,"discounted_cash":169.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1034.0,"discounted_cash":361.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3710.0,"discounted_cash":1298.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":581.0,"discounted_cash":203.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4202.0,"discounted_cash":1470.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1241.0,"discounted_cash":434.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4202.0,"discounted_cash":1470.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1241.0,"discounted_cash":434.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED ESOPHAGOSCOPY FLEXIBLE BRUSH CDM","code_information":[{"code":"Px00045013237","type":"CDM"},{"code":"43200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1516.0,"discounted_cash":530.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3105.0,"discounted_cash":1086.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3105.0,"discounted_cash":1086.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":890.0,"discounted_cash":311.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":399.0,"discounted_cash":139.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1742.0,"discounted_cash":609.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED CARDIOPULMONARY RESUSCITATION CDM","code_information":[{"code":"Px00045014038","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.0,"discounted_cash":221.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":8064.0,"discounted_cash":2822.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4248.0,"discounted_cash":1486.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3202.0,"discounted_cash":1120.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED FAC PERITONEAL LAVAGE CDM","code_information":[{"code":"Px00045014048","type":"CDM"},{"code":"49084","type":"HCPCS"}],"standard_charges":[{"gross_charge":2478.0,"discounted_cash":867.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC ANOSCOPY CDM","code_information":[{"code":"Px00045014050","type":"CDM"},{"code":"46601","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":139.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":739.0,"discounted_cash":258.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9045.0,"discounted_cash":3165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3445.0,"discounted_cash":1205.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3410.0,"discounted_cash":1193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":10891.0,"discounted_cash":3811.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5805.0,"discounted_cash":2031.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4833.0,"discounted_cash":1691.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4371.0,"discounted_cash":1529.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC UC TX NURSEMAID ELBOW W MANIP","code_information":[{"code":"Px00045600041","type":"CDM"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC UC DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE","code_information":[{"code":"Px00045600080","type":"CDM"},{"code":"69000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":597.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":523.0,"discounted_cash":183.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":260.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CO/MEMBANE DIFFUSE CAPACITY","code_information":[{"code":"Px00046010012","type":"CDM"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":160.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":380.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":443.0,"discounted_cash":155.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":273.0,"discounted_cash":95.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":173.0,"discounted_cash":60.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":260.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RESPIRATORY FLOW VOLUME LOOP","code_information":[{"code":"Px00046010053","type":"CDM"},{"code":"94375","type":"HCPCS"}],"standard_charges":[{"gross_charge":523.0,"discounted_cash":183.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":445.0,"discounted_cash":155.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SPIROMETRY PRE POST BRONCHODILATOR CDM","code_information":[{"code":"Px00046010063","type":"CDM"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1437.0,"discounted_cash":502.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":625.0,"discounted_cash":218.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC VITAL CAPACITY, TOTAL (SEPARATE PROCEDURE)","code_information":[{"code":"Px00046010090","type":"CDM"},{"code":"94150","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":445.0,"discounted_cash":155.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC HEARING SCREEN INPT CDM","code_information":[{"code":"Px00047010029","type":"CDM"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC HEARING SCREEN OUTPT CDM","code_information":[{"code":"Px00047010030","type":"CDM"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC HEARING SCREEN OUTPT-RESCREEN CDM","code_information":[{"code":"Px00047010032","type":"CDM"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6118.0,"discounted_cash":2141.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL","code_information":[{"code":"Px00048010001","type":"CDM"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":1586.0,"discounted_cash":555.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX","code_information":[{"code":"Px00048010002","type":"CDM"},{"code":"92961","type":"HCPCS"}],"standard_charges":[{"gross_charge":1342.0,"discounted_cash":469.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3715.0,"discounted_cash":1300.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1510.0,"discounted_cash":528.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":8538.0,"discounted_cash":2988.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2462.0,"discounted_cash":861.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":625.0,"discounted_cash":218.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1162.0,"discounted_cash":406.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1499.0,"discounted_cash":524.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6330.0,"discounted_cash":2215.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11955.0,"discounted_cash":4184.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5828.0,"discounted_cash":2039.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2520.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":258.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PRE-OP ICD DEVICE EVAL","code_information":[{"code":"Px00048010089","type":"CDM"},{"code":"93287","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTRAVENTRICULAR PACING","code_information":[{"code":"Px00048010097","type":"CDM"},{"code":"93612","type":"HCPCS"}],"standard_charges":[{"gross_charge":16651.0,"discounted_cash":5827.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REM INTERROG PM/LDLS PM/IDS LTE 90 DAYS TECH REVIEW","code_information":[{"code":"Px00048010099","type":"CDM"},{"code":"93296","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":31.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING","code_information":[{"code":"Px00048010109","type":"CDM"},{"code":"93613","type":"HCPCS"}],"standard_charges":[{"gross_charge":10754.0,"discounted_cash":3763.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INDUCTION ARRHYTHMIA ELECTRICAL PACING","code_information":[{"code":"Px00048010110","type":"CDM"},{"code":"93618","type":"HCPCS"}],"standard_charges":[{"gross_charge":3628.0,"discounted_cash":1269.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":23601.0,"discounted_cash":8260.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION","code_information":[{"code":"Px00048010112","type":"CDM"},{"code":"93620","type":"HCPCS"}],"standard_charges":[{"gross_charge":23634.0,"discounted_cash":8271.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6784.0,"discounted_cash":2374.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6784.0,"discounted_cash":2374.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3241.0,"discounted_cash":1134.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1479.0,"discounted_cash":517.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4507.0,"discounted_cash":1577.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":7768.0,"discounted_cash":2718.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11739.0,"discounted_cash":4108.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11986.0,"discounted_cash":4195.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":17654.0,"discounted_cash":6178.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CARDIOPULMONARY RESUSCITATION (CARDIAC ARREST)","code_information":[{"code":"Px00048010135","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.0,"discounted_cash":221.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MEDICATION ADMIN & HEMODYNAMIC MEASURMENT CDM","code_information":[{"code":"Px00048010140","type":"CDM"},{"code":"93463","type":"HCPCS"}],"standard_charges":[{"gross_charge":1079.0,"discounted_cash":377.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR","code_information":[{"code":"Px00048010160","type":"CDM"},{"code":"93644","type":"HCPCS"}],"standard_charges":[{"gross_charge":7768.0,"discounted_cash":2718.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REVASC LITHOTRIP TIBI/PERONE CDM","code_information":[{"code":"Px00048100011","type":"CDM"},{"code":"C9772","type":"HCPCS"}],"standard_charges":[{"gross_charge":54952.0,"discounted_cash":19233.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":25355.0,"discounted_cash":8874.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":625.0,"discounted_cash":218.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1776.0,"discounted_cash":621.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1776.0,"discounted_cash":621.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":19300.0,"discounted_cash":6755.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12319.0,"discounted_cash":4311.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":75981.0,"discounted_cash":26593.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":75981.0,"discounted_cash":26593.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":28012.0,"discounted_cash":9804.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":28012.0,"discounted_cash":9804.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12319.0,"discounted_cash":4311.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12319.0,"discounted_cash":4311.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12319.0,"discounted_cash":4311.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12319.0,"discounted_cash":4311.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":75981.0,"discounted_cash":26593.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2094.0,"discounted_cash":732.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6190.0,"discounted_cash":2166.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":105.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":105.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3456.0,"discounted_cash":1209.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4109.0,"discounted_cash":1438.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11464.0,"discounted_cash":4012.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":30186.0,"discounted_cash":10565.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":37733.0,"discounted_cash":13206.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR A-AO NDGFT","code_information":[{"code":"Px00048110004","type":"CDM"},{"code":"34701","type":"HCPCS"}],"standard_charges":[{"gross_charge":9812.0,"discounted_cash":3434.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9812.0,"discounted_cash":3434.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR A-UNILAC NDGFT","code_information":[{"code":"Px00048110006","type":"CDM"},{"code":"34703","type":"HCPCS"}],"standard_charges":[{"gross_charge":9812.0,"discounted_cash":3434.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9812.0,"discounted_cash":3434.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EVAC RPR A-BIILIAC NDGFT","code_information":[{"code":"Px00048110008","type":"CDM"},{"code":"34705","type":"HCPCS"}],"standard_charges":[{"gross_charge":9812.0,"discounted_cash":3434.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR A-BIILIAC RPT","code_information":[{"code":"Px00048110010","type":"CDM"},{"code":"34706","type":"HCPCS"}],"standard_charges":[{"gross_charge":9812.0,"discounted_cash":3434.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":20582.0,"discounted_cash":7203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":13144.0,"discounted_cash":4600.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":17952.0,"discounted_cash":6283.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11464.0,"discounted_cash":4012.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":18848.0,"discounted_cash":6596.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12032.0,"discounted_cash":4211.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":19748.0,"discounted_cash":6911.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":18848.0,"discounted_cash":6596.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12032.0,"discounted_cash":4211.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":33921.0,"discounted_cash":11872.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":40396.0,"discounted_cash":14138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9716.0,"discounted_cash":3400.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":40396.0,"discounted_cash":14138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9716.0,"discounted_cash":3400.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12234.0,"discounted_cash":4281.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4270.0,"discounted_cash":1494.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12234.0,"discounted_cash":4281.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4270.0,"discounted_cash":1494.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":17952.0,"discounted_cash":6283.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11464.0,"discounted_cash":4012.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":17952.0,"discounted_cash":6283.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11464.0,"discounted_cash":4012.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":18848.0,"discounted_cash":6596.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12032.0,"discounted_cash":4211.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":19748.0,"discounted_cash":6911.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":18848.0,"discounted_cash":6596.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12032.0,"discounted_cash":4211.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR ILIO-ILIAC NDGFT","code_information":[{"code":"Px00048110042","type":"CDM"},{"code":"34707","type":"HCPCS"}],"standard_charges":[{"gross_charge":9812.0,"discounted_cash":3434.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR ILIO-ILIAC RPT","code_information":[{"code":"Px00048110043","type":"CDM"},{"code":"34708","type":"HCPCS"}],"standard_charges":[{"gross_charge":9812.0,"discounted_cash":3434.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PLMT XTN PROSTH EVASC RPR","code_information":[{"code":"Px00048110044","type":"CDM"},{"code":"34709","type":"HCPCS"}],"standard_charges":[{"gross_charge":4582.0,"discounted_cash":1603.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6890.0,"discounted_cash":2411.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3445.0,"discounted_cash":1205.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PERQ ACCESS & CLSR FEM ART","code_information":[{"code":"Px00048110048","type":"CDM"},{"code":"34713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4906.0,"discounted_cash":1717.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CORONARY THROMBECTOMY ASP","code_information":[{"code":"Px00048110059","type":"CDM"},{"code":"93799","type":"HCPCS"}],"standard_charges":[{"gross_charge":1776.0,"discounted_cash":621.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC THROMBOLYSIS CORONARY INTRAVENOUS INFUSION","code_information":[{"code":"Px00048110072","type":"CDM"},{"code":"92977","type":"HCPCS"}],"standard_charges":[{"gross_charge":7851.0,"discounted_cash":2747.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REVASC INTRAVASC LITHOTRIPSY","code_information":[{"code":"Px00048110073","type":"CDM"},{"code":"C9764","type":"HCPCS"}],"standard_charges":[{"gross_charge":20582.0,"discounted_cash":7203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REVASC INTRA LITHOTRIP-STENT","code_information":[{"code":"Px00048110074","type":"CDM"},{"code":"C9765","type":"HCPCS"}],"standard_charges":[{"gross_charge":54952.0,"discounted_cash":19233.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY","code_information":[{"code":"Px00048110101","type":"CDM"},{"code":"92973","type":"HCPCS"}],"standard_charges":[{"gross_charge":2285.0,"discounted_cash":799.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CATH PLACE CARDIO BRACHYTX","code_information":[{"code":"Px00048110102","type":"CDM"},{"code":"92974","type":"HCPCS"}],"standard_charges":[{"gross_charge":3323.0,"discounted_cash":1163.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC THROMBOLYSIS INTRACORONARY NFS SLCTV ANGRPH","code_information":[{"code":"Px00048110103","type":"CDM"},{"code":"92975","type":"HCPCS"}],"standard_charges":[{"gross_charge":8064.0,"discounted_cash":2822.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5504.0,"discounted_cash":1926.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2796.0,"discounted_cash":978.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REVISION OF AORTIC VALVE","code_information":[{"code":"Px00048110115","type":"CDM"},{"code":"92986","type":"HCPCS"}],"standard_charges":[{"gross_charge":5104.0,"discounted_cash":1786.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REVISION OF MITRAL VALVE","code_information":[{"code":"Px00048110116","type":"CDM"},{"code":"92987","type":"HCPCS"}],"standard_charges":[{"gross_charge":15981.0,"discounted_cash":5593.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9432.0,"discounted_cash":3301.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC LEFT HRT CATH W/VENTRCLGRPHY","code_information":[{"code":"Px00048110142","type":"CDM"},{"code":"93452","type":"HCPCS"}],"standard_charges":[{"gross_charge":16165.0,"discounted_cash":5657.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":13001.0,"discounted_cash":4550.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":11589.0,"discounted_cash":4056.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":14312.0,"discounted_cash":5009.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":13001.0,"discounted_cash":4550.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":13001.0,"discounted_cash":4550.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":14906.0,"discounted_cash":5217.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":17205.0,"discounted_cash":6021.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":17146.0,"discounted_cash":6001.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":19160.0,"discounted_cash":6706.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3346.0,"discounted_cash":1171.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MEDICATION ADMIN & HEMODYNAMIC MEASURMENT","code_information":[{"code":"Px00048110153","type":"CDM"},{"code":"93463","type":"HCPCS"}],"standard_charges":[{"gross_charge":1079.0,"discounted_cash":377.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1750.0,"discounted_cash":612.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2450.0,"discounted_cash":857.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2616.0,"discounted_cash":915.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1962.0,"discounted_cash":686.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC BUNDLE OF HIS RECORDING","code_information":[{"code":"Px00048110193","type":"CDM"},{"code":"93600","type":"HCPCS"}],"standard_charges":[{"gross_charge":8836.0,"discounted_cash":3092.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTRA-ATRIAL RECORDING","code_information":[{"code":"Px00048110194","type":"CDM"},{"code":"93602","type":"HCPCS"}],"standard_charges":[{"gross_charge":14524.0,"discounted_cash":5083.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RIGHT VENTRICULAR RECORDING","code_information":[{"code":"Px00048110195","type":"CDM"},{"code":"93603","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.0,"discounted_cash":408.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":962.0,"discounted_cash":336.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INTRA-ATRIAL PACING","code_information":[{"code":"Px00048110197","type":"CDM"},{"code":"93610","type":"HCPCS"}],"standard_charges":[{"gross_charge":8579.0,"discounted_cash":3002.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ILIAC ART ANGIO,CARDIAC CATH","code_information":[{"code":"Px00048110224","type":"CDM"},{"code":"G0278","type":"HCPCS"}],"standard_charges":[{"gross_charge":5221.0,"discounted_cash":1827.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ECMO/ECLS INITIATION VENO-VENOUS","code_information":[{"code":"Px00048110410","type":"CDM"},{"code":"33946","type":"HCPCS"}],"standard_charges":[{"gross_charge":6130.0,"discounted_cash":2145.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ECMO/ECLS INITIATION VENO-ARTERIAL","code_information":[{"code":"Px00048110411","type":"CDM"},{"code":"33947","type":"HCPCS"}],"standard_charges":[{"gross_charge":6130.0,"discounted_cash":2145.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12724.0,"discounted_cash":4453.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2004.0,"discounted_cash":701.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":812.0,"discounted_cash":284.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5245.0,"discounted_cash":1835.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1316.0,"discounted_cash":460.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5245.0,"discounted_cash":1835.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":698.0,"discounted_cash":244.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ECHO DOPPLER PULSE CONTIN LTD","code_information":[{"code":"Px00048310013","type":"CDM"},{"code":"93321","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":218.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1975.0,"discounted_cash":691.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":5828.0,"discounted_cash":2039.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EXCISION PILONIDAL CYST/SINUS SIMPLE  CDM","code_information":[{"code":"Px00051010346","type":"CDM"},{"code":"11770","type":"HCPCS"}],"standard_charges":[{"gross_charge":12426.0,"discounted_cash":4349.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/OR LESS CDM","code_information":[{"code":"Px00051010349","type":"CDM"},{"code":"14020","type":"HCPCS"}],"standard_charges":[{"gross_charge":4698.0,"discounted_cash":1644.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EXC FACE TUM DEEP 2+ CM","code_information":[{"code":"Px00051010355","type":"CDM"},{"code":"21014","type":"HCPCS"}],"standard_charges":[{"gross_charge":5933.0,"discounted_cash":2076.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3860.0,"discounted_cash":1351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1241.0,"discounted_cash":434.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":949.0,"discounted_cash":332.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":543.0,"discounted_cash":190.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4  CDM","code_information":[{"code":"Px00051010404","type":"CDM"},{"code":"11056","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":231.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":847.0,"discounted_cash":296.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS CDM","code_information":[{"code":"Px00051010409","type":"CDM"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1708.0,"discounted_cash":597.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1776.0,"discounted_cash":621.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1848.0,"discounted_cash":646.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4  CDM","code_information":[{"code":"Px00051010420","type":"CDM"},{"code":"11057","type":"HCPCS"}],"standard_charges":[{"gross_charge":732.0,"discounted_cash":256.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM  CDM","code_information":[{"code":"Px00051010428","type":"CDM"},{"code":"11601","type":"HCPCS"}],"standard_charges":[{"gross_charge":2204.0,"discounted_cash":771.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM CDM","code_information":[{"code":"Px00051010429","type":"CDM"},{"code":"11602","type":"HCPCS"}],"standard_charges":[{"gross_charge":2204.0,"discounted_cash":771.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM  CDM","code_information":[{"code":"Px00051010431","type":"CDM"},{"code":"11606","type":"HCPCS"}],"standard_charges":[{"gross_charge":5079.0,"discounted_cash":1777.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","code_information":[{"code":"Px00051010440","type":"CDM"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS  CDM","code_information":[{"code":"Px00051010441","type":"CDM"},{"code":"11900","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM CDM","code_information":[{"code":"Px00051010463","type":"CDM"},{"code":"11603","type":"HCPCS"}],"standard_charges":[{"gross_charge":2204.0,"discounted_cash":771.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MC ASSESSMT SOCIAL WORKER PER 30M","code_information":[{"code":"Px00051010504","type":"CDM"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MC HRIF CLINIC COORDINATOR","code_information":[{"code":"Px00051010505","type":"CDM"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM  CDM","code_information":[{"code":"Px00051010626","type":"CDM"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":159.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM  CDM","code_information":[{"code":"Px00051010632","type":"CDM"},{"code":"12004","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":163.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MRI IMAGE JAW JOINT TMJ","code_information":[{"code":"Px00061010002","type":"CDM"},{"code":"70336","type":"HCPCS"}],"standard_charges":[{"gross_charge":5195.0,"discounted_cash":1818.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2120.0,"discounted_cash":742.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI ORBIT/FACE/NECK W CONTRAST","code_information":[{"code":"Px00061010005","type":"CDM"},{"code":"70542","type":"HCPCS"}],"standard_charges":[{"gross_charge":5579.0,"discounted_cash":1952.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2571.0,"discounted_cash":899.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI ORBIT/FACE/NECK WO & W CONTRAST","code_information":[{"code":"Px00061010007","type":"CDM"},{"code":"70543","type":"HCPCS"}],"standard_charges":[{"gross_charge":6213.0,"discounted_cash":2174.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3246.0,"discounted_cash":1136.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRA HEAD WO CONTRAST","code_information":[{"code":"Px00061010009","type":"CDM"},{"code":"70544","type":"HCPCS"}],"standard_charges":[{"gross_charge":5469.0,"discounted_cash":1914.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2120.0,"discounted_cash":742.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRA HEAD W CONTRAST","code_information":[{"code":"Px00061010010","type":"CDM"},{"code":"70545","type":"HCPCS"}],"standard_charges":[{"gross_charge":6199.0,"discounted_cash":2169.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2571.0,"discounted_cash":899.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRA HEAD WO & W CONTRAST","code_information":[{"code":"Px00061010012","type":"CDM"},{"code":"70546","type":"HCPCS"}],"standard_charges":[{"gross_charge":6958.0,"discounted_cash":2435.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3244.0,"discounted_cash":1135.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRA NECK WO CONTRAST","code_information":[{"code":"Px00061010013","type":"CDM"},{"code":"70547","type":"HCPCS"}],"standard_charges":[{"gross_charge":5469.0,"discounted_cash":1914.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2120.0,"discounted_cash":742.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRA NECK W CONTRAST","code_information":[{"code":"Px00061010014","type":"CDM"},{"code":"70548","type":"HCPCS"}],"standard_charges":[{"gross_charge":6199.0,"discounted_cash":2169.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2571.0,"discounted_cash":899.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRA NECK WO & W CONTRAST","code_information":[{"code":"Px00061010015","type":"CDM"},{"code":"70549","type":"HCPCS"}],"standard_charges":[{"gross_charge":6958.0,"discounted_cash":2435.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3244.0,"discounted_cash":1135.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI CHEST WO CONTRAST","code_information":[{"code":"Px00061010019","type":"CDM"},{"code":"71550","type":"HCPCS"}],"standard_charges":[{"gross_charge":5987.0,"discounted_cash":2095.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2120.0,"discounted_cash":742.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI CHEST WO CONTRAST","code_information":[{"code":"Px00061010022","type":"CDM"},{"code":"71551","type":"HCPCS"}],"standard_charges":[{"gross_charge":6940.0,"discounted_cash":2429.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2571.0,"discounted_cash":899.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI CHEST WO & W CONTRAST","code_information":[{"code":"Px00061010025","type":"CDM"},{"code":"71552","type":"HCPCS"}],"standard_charges":[{"gross_charge":8674.0,"discounted_cash":3035.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3244.0,"discounted_cash":1135.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI PELVIS WO CONTRAST","code_information":[{"code":"Px00061010029","type":"CDM"},{"code":"72195","type":"HCPCS"}],"standard_charges":[{"gross_charge":5566.0,"discounted_cash":1948.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2120.0,"discounted_cash":742.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI PELVIS W CONTRAST","code_information":[{"code":"Px00061010038","type":"CDM"},{"code":"72196","type":"HCPCS"}],"standard_charges":[{"gross_charge":6407.0,"discounted_cash":2242.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2571.0,"discounted_cash":899.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI PELVIS WO & W CONTRAST","code_information":[{"code":"Px00061010044","type":"CDM"},{"code":"72197","type":"HCPCS"}],"standard_charges":[{"gross_charge":8401.0,"discounted_cash":2940.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3246.0,"discounted_cash":1136.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI LOWER EXTREMITY NO JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010053","type":"CDM"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":6395.0,"discounted_cash":2238.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3246.0,"discounted_cash":1136.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI UPPER EXTREMITY NO JOINT WO CONTRAST","code_information":[{"code":"Px00061010054","type":"CDM"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":4201.0,"discounted_cash":1470.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2120.0,"discounted_cash":742.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI LOWER EXTREMITY NO JOINT W CONTRAST","code_information":[{"code":"Px00061010057","type":"CDM"},{"code":"73719","type":"HCPCS"}],"standard_charges":[{"gross_charge":5938.0,"discounted_cash":2078.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2571.0,"discounted_cash":899.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI UPPER EXTREMITY NO JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010059","type":"CDM"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":5321.0,"discounted_cash":1862.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3246.0,"discounted_cash":1136.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI BREAST CAD ADD ON CDM","code_information":[{"code":"Px00061010060","type":"CDM"},{"code":"C8937","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":142.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4202.0,"discounted_cash":1470.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2120.0,"discounted_cash":742.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI LOWER EXTREMITY NO JOINT WO CONTRAST","code_information":[{"code":"Px00061010065","type":"CDM"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":4342.0,"discounted_cash":1519.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2120.0,"discounted_cash":742.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI UPPER EXTREMITY JOINT W CONTRAST","code_information":[{"code":"Px00061010066","type":"CDM"},{"code":"73222","type":"HCPCS"}],"standard_charges":[{"gross_charge":5401.0,"discounted_cash":1890.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2571.0,"discounted_cash":899.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI UPPER EXTREMITY JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010068","type":"CDM"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":6838.0,"discounted_cash":2393.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3246.0,"discounted_cash":1136.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI LOWER EXTREMITY JOINT WO CONTRAST","code_information":[{"code":"Px00061010075","type":"CDM"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":4342.0,"discounted_cash":1519.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2120.0,"discounted_cash":742.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI LOWER EXTREMITY JOINT W CONTRAST","code_information":[{"code":"Px00061010077","type":"CDM"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":5345.0,"discounted_cash":1870.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2571.0,"discounted_cash":899.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI LOWER EXTREMITY JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010079","type":"CDM"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":6940.0,"discounted_cash":2429.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3246.0,"discounted_cash":1136.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI MRCP ABDOMEN WO CONTRAST","code_information":[{"code":"Px00061010082","type":"CDM"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":6407.0,"discounted_cash":2242.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2120.0,"discounted_cash":742.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI ABDOMEN WO CONTRAST","code_information":[{"code":"Px00061010083","type":"CDM"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":6407.0,"discounted_cash":2242.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2120.0,"discounted_cash":742.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI ABDOMEN W CONTRAST","code_information":[{"code":"Px00061010085","type":"CDM"},{"code":"74182","type":"HCPCS"}],"standard_charges":[{"gross_charge":7567.0,"discounted_cash":2648.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2571.0,"discounted_cash":899.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI ABDOMEN WO & W CONTRAST","code_information":[{"code":"Px00061010087","type":"CDM"},{"code":"74183","type":"HCPCS"}],"standard_charges":[{"gross_charge":8726.0,"discounted_cash":3054.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3246.0,"discounted_cash":1136.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI SPECTROSCOPY","code_information":[{"code":"Px00061010095","type":"CDM"},{"code":"76390","type":"HCPCS"}],"standard_charges":[{"gross_charge":1085.0,"discounted_cash":379.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":337.0,"discounted_cash":117.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI BONE MARROW BLOOD SUPPLY","code_information":[{"code":"Px00061010100","type":"CDM"},{"code":"77084","type":"HCPCS"}],"standard_charges":[{"gross_charge":4342.0,"discounted_cash":1519.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2120.0,"discounted_cash":742.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRA LOWER EXTREMITY W/WO CONTRAST","code_information":[{"code":"Px00061010114","type":"CDM"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":10382.0,"discounted_cash":3633.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2369.0,"discounted_cash":829.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRA LOWER EXTREMITY W/WO CONTRAST","code_information":[{"code":"Px00061010115","type":"CDM"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":10382.0,"discounted_cash":3633.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1895.0,"discounted_cash":663.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRA LOWER EXTREMITY W/WO CONTRAST","code_information":[{"code":"Px00061010116","type":"CDM"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":10382.0,"discounted_cash":3633.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2962.0,"discounted_cash":1036.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRA W/O AND W/CONT SPINAL CANAL","code_information":[{"code":"Px00061010122","type":"CDM"},{"code":"72159","type":"HCPCS"}],"standard_charges":[{"gross_charge":6940.0,"discounted_cash":2429.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3777.0,"discounted_cash":1321.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRA W/CONTRAST UPPER EXTREMITY","code_information":[{"code":"Px00061010123","type":"CDM"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":8478.0,"discounted_cash":2967.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3022.0,"discounted_cash":1057.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRA W/O CONTRAST UPPER EXTREMITY","code_information":[{"code":"Px00061010124","type":"CDM"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":8478.0,"discounted_cash":2967.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2418.0,"discounted_cash":846.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRA W/O AND W/CONT UPPER EXTREMITY","code_information":[{"code":"Px00061010125","type":"CDM"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":8478.0,"discounted_cash":2967.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3777.0,"discounted_cash":1321.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI UPPER EXTREMITY W/DYE","code_information":[{"code":"Px00061010137","type":"CDM"},{"code":"73219","type":"HCPCS"}],"standard_charges":[{"gross_charge":4993.0,"discounted_cash":1747.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2571.0,"discounted_cash":899.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI ORBIT/FACE/NECK W/O DYE","code_information":[{"code":"Px00061010142","type":"CDM"},{"code":"70540","type":"HCPCS"}],"standard_charges":[{"gross_charge":4944.0,"discounted_cash":1730.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2120.0,"discounted_cash":742.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRA CHEST W/O & W/CONTRAST MATERIAL","code_information":[{"code":"Px00061010143","type":"CDM"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":8674.0,"discounted_cash":3035.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2378.0,"discounted_cash":832.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRA CHEST W/O & W/CONTRAST MATERIAL","code_information":[{"code":"Px00061010144","type":"CDM"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":8674.0,"discounted_cash":3035.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1903.0,"discounted_cash":666.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRA CHEST W/O & W/CONTRAST MATERIAL","code_information":[{"code":"Px00061010145","type":"CDM"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":8674.0,"discounted_cash":3035.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2973.0,"discounted_cash":1040.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MR ANGIO PELVIS W/O DYE","code_information":[{"code":"Px00061010148","type":"CDM"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":10382.0,"discounted_cash":3633.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":1895.0,"discounted_cash":663.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI ANGIO ABDOM W & W/O DYE","code_information":[{"code":"Px00061010237","type":"CDM"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":8674.0,"discounted_cash":3035.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2951.0,"discounted_cash":1032.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI ANGIO ABDOM W/DYE","code_information":[{"code":"Px00061010238","type":"CDM"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":8674.0,"discounted_cash":3035.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2625.0,"discounted_cash":918.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI ANGIO ABDOM W/O DYE","code_information":[{"code":"Px00061010239","type":"CDM"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":8674.0,"discounted_cash":3035.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2100.0,"discounted_cash":735.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI BREAST WITHOUT CONTRAST UNILATERAL","code_information":[{"code":"Px00061010279","type":"CDM"},{"code":"77046","type":"HCPCS"}],"standard_charges":[{"gross_charge":4202.0,"discounted_cash":1470.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3957.0,"discounted_cash":1384.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI BREAST WITHOUT CONTRAST BILATERAL","code_information":[{"code":"Px00061010280","type":"CDM"},{"code":"77047","type":"HCPCS"}],"standard_charges":[{"gross_charge":6395.0,"discounted_cash":2238.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":4198.0,"discounted_cash":1469.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":6395.0,"discounted_cash":2238.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3957.0,"discounted_cash":1384.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"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":6940.0,"discounted_cash":2429.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":4198.0,"discounted_cash":1469.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI BRAIN STEM W/O DYE","code_information":[{"code":"Px00061110001","type":"CDM"},{"code":"70551","type":"HCPCS"}],"standard_charges":[{"gross_charge":5579.0,"discounted_cash":1952.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2120.0,"discounted_cash":742.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI BRAIN W/DYE","code_information":[{"code":"Px00061110007","type":"CDM"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":6791.0,"discounted_cash":2376.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2571.0,"discounted_cash":899.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI BRAIN W/DYE W/FIDUCIAL MRKRS","code_information":[{"code":"Px00061110010","type":"CDM"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":6791.0,"discounted_cash":2376.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2571.0,"discounted_cash":899.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI BRAIN W/DYE W/O FIDUCIAL MRKRS","code_information":[{"code":"Px00061110011","type":"CDM"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":6791.0,"discounted_cash":2376.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2571.0,"discounted_cash":899.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI BRAIN W/O & W/DYE","code_information":[{"code":"Px00061110015","type":"CDM"},{"code":"70553","type":"HCPCS"}],"standard_charges":[{"gross_charge":8474.0,"discounted_cash":2965.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3246.0,"discounted_cash":1136.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI CERVICAL SPINE W/O DYE","code_information":[{"code":"Px00061210001","type":"CDM"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":6410.0,"discounted_cash":2243.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2120.0,"discounted_cash":742.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI CERVICAL SPINE W/DYE","code_information":[{"code":"Px00061210003","type":"CDM"},{"code":"72142","type":"HCPCS"}],"standard_charges":[{"gross_charge":6958.0,"discounted_cash":2435.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2571.0,"discounted_cash":899.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI THORACIC SPINE W/O DYE","code_information":[{"code":"Px00061210005","type":"CDM"},{"code":"72146","type":"HCPCS"}],"standard_charges":[{"gross_charge":6395.0,"discounted_cash":2238.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2120.0,"discounted_cash":742.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI THORACIC SPINE W/DYE","code_information":[{"code":"Px00061210007","type":"CDM"},{"code":"72147","type":"HCPCS"}],"standard_charges":[{"gross_charge":6940.0,"discounted_cash":2429.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2536.0,"discounted_cash":887.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI LUMBAR SPINE W/O DYE","code_information":[{"code":"Px00061210009","type":"CDM"},{"code":"72148","type":"HCPCS"}],"standard_charges":[{"gross_charge":6395.0,"discounted_cash":2238.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2120.0,"discounted_cash":742.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI LUMBAR SPINE W/DYE","code_information":[{"code":"Px00061210011","type":"CDM"},{"code":"72149","type":"HCPCS"}],"standard_charges":[{"gross_charge":6940.0,"discounted_cash":2429.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2571.0,"discounted_cash":899.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI CERVICAL SPINE W/O & W/DYE","code_information":[{"code":"Px00061210013","type":"CDM"},{"code":"72156","type":"HCPCS"}],"standard_charges":[{"gross_charge":8747.0,"discounted_cash":3061.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3246.0,"discounted_cash":1136.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI THORACIC SPINE W/O & W/DYE","code_information":[{"code":"Px00061210015","type":"CDM"},{"code":"72157","type":"HCPCS"}],"standard_charges":[{"gross_charge":8726.0,"discounted_cash":3054.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3246.0,"discounted_cash":1136.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRI LUMBAR SPINE W/O & W/DYE","code_information":[{"code":"Px00061210017","type":"CDM"},{"code":"72158","type":"HCPCS"}],"standard_charges":[{"gross_charge":8726.0,"discounted_cash":3054.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":3246.0,"discounted_cash":1136.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MRA PELVIS WO & W CONTRAST","code_information":[{"code":"Px00061210028","type":"CDM"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":10382.0,"discounted_cash":3633.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2962.0,"discounted_cash":1036.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC MR ANGIO PELVIS W/DYE","code_information":[{"code":"Px00061810001","type":"CDM"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":10382.0,"discounted_cash":3633.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"},{"gross_charge":2369.0,"discounted_cash":829.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT OUTPATIENT"}]},{"description":"HC APLIGRAF PER SQ CM (63610006)","code_information":[{"code":"Px00063610006","type":"CDM"},{"code":"Q4101","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SKIN SUB DERMAGRAFT PER SQ CM","code_information":[{"code":"Px00063610010","type":"CDM"},{"code":"Q4106","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OP OASIS WOUND MATRIX PER SQ CM","code_information":[{"code":"Px00063610015","type":"CDM"},{"code":"Q4102","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC OP OASIS ULTRATRILAYER MTRX SQ CM","code_information":[{"code":"Px00063610031","type":"CDM"},{"code":"Q4124","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PR RX RHO D IMMUNE GLOBULIN INJ 300 MCG (1500 IU)","code_information":[{"code":"Px00063610194","type":"CDM"},{"code":"J2790","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.0,"discounted_cash":233.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC R&B HOSPICE ACUTE","code_information":[{"code":"Px00065610001","type":"CDM"}],"standard_charges":[{"gross_charge":6809.0,"discounted_cash":2383.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ANGIO RECOVERY MAJOR","code_information":[{"code":"Px00071010103","type":"CDM"}],"standard_charges":[{"gross_charge":3927.0,"discounted_cash":1374.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ANGIO RECOVERY MINOR","code_information":[{"code":"Px00071010104","type":"CDM"}],"standard_charges":[{"gross_charge":1391.0,"discounted_cash":486.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 1 INITIAL 15","code_information":[{"code":"Px00071010131","type":"CDM"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":199.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 2 INITIAL 15","code_information":[{"code":"Px00071010132","type":"CDM"}],"standard_charges":[{"gross_charge":640.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 3 INITIAL 15","code_information":[{"code":"Px00071010133","type":"CDM"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":299.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 4 INITIAL 15","code_information":[{"code":"Px00071010134","type":"CDM"}],"standard_charges":[{"gross_charge":997.0,"discounted_cash":348.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 5 INITIAL 15","code_information":[{"code":"Px00071010135","type":"CDM"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 1 PER MIN","code_information":[{"code":"Px00071010231","type":"CDM"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 2 PER MIN","code_information":[{"code":"Px00071010232","type":"CDM"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 3 PER MIN","code_information":[{"code":"Px00071010233","type":"CDM"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 4 PER MIN","code_information":[{"code":"Px00071010234","type":"CDM"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":15.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RECOVERY","code_information":[{"code":"Px00071010267","type":"CDM"}],"standard_charges":[{"gross_charge":1799.0,"discounted_cash":629.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RECOVERY 1 HR","code_information":[{"code":"Px00071010268","type":"CDM"}],"standard_charges":[{"gross_charge":1391.0,"discounted_cash":486.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC RECOVERY ADDL 15 MIN","code_information":[{"code":"Px00071010272","type":"CDM"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 5 PER MIN","code_information":[{"code":"Px00071010358","type":"CDM"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":16.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 1 CDM","code_information":[{"code":"Px00072210001","type":"CDM"}],"standard_charges":[{"gross_charge":4651.0,"discounted_cash":1627.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 2 CDM","code_information":[{"code":"Px00072210002","type":"CDM"}],"standard_charges":[{"gross_charge":5088.0,"discounted_cash":1780.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 3 CDM","code_information":[{"code":"Px00072210003","type":"CDM"}],"standard_charges":[{"gross_charge":9682.0,"discounted_cash":3388.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 4 CDM","code_information":[{"code":"Px00072210004","type":"CDM"}],"standard_charges":[{"gross_charge":10511.0,"discounted_cash":3678.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CIRCUMCISION W/REGIONL BLOCK CDM","code_information":[{"code":"Px00072310001","type":"CDM"},{"code":"54150","type":"HCPCS"}],"standard_charges":[{"gross_charge":3434.0,"discounted_cash":1201.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ECG 12 LEAD TRACING ONLY","code_information":[{"code":"Px00073010002","type":"CDM"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":945.0,"discounted_cash":330.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EEG EXTENDED MONITORING 41-60 MINUTES","code_information":[{"code":"Px00074010013","type":"CDM"},{"code":"95812","type":"HCPCS"}],"standard_charges":[{"gross_charge":1701.0,"discounted_cash":595.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY","code_information":[{"code":"Px00074010015","type":"CDM"},{"code":"95816","type":"HCPCS"}],"standard_charges":[{"gross_charge":3969.0,"discounted_cash":1389.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EEG AWAKE AND ASLEEP","code_information":[{"code":"Px00074010018","type":"CDM"},{"code":"95819","type":"HCPCS"}],"standard_charges":[{"gross_charge":1793.0,"discounted_cash":627.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EEG COMA OR SLEEP ONLY","code_information":[{"code":"Px00074010020","type":"CDM"},{"code":"95822","type":"HCPCS"}],"standard_charges":[{"gross_charge":3969.0,"discounted_cash":1389.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EEG CEREBRAL DEATH ONLY","code_information":[{"code":"Px00074010022","type":"CDM"},{"code":"95824","type":"HCPCS"}],"standard_charges":[{"gross_charge":5189.0,"discounted_cash":1816.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EEG- SSEP UPPERS & LOWERS","code_information":[{"code":"Px00074010044","type":"CDM"},{"code":"95938","type":"HCPCS"}],"standard_charges":[{"gross_charge":2670.0,"discounted_cash":934.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC MOTOR EVOKED UPR&LWR LIMBS","code_information":[{"code":"Px00074010045","type":"CDM"},{"code":"95939","type":"HCPCS"}],"standard_charges":[{"gross_charge":2652.0,"discounted_cash":928.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1873.0,"discounted_cash":655.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1873.0,"discounted_cash":655.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3006.0,"discounted_cash":1052.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4046.0,"discounted_cash":1416.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6071.0,"discounted_cash":2124.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9100.0,"discounted_cash":3185.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12138.0,"discounted_cash":4248.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1967.0,"discounted_cash":688.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3155.0,"discounted_cash":1104.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4243.0,"discounted_cash":1485.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":6365.0,"discounted_cash":2227.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":9544.0,"discounted_cash":3340.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":12732.0,"discounted_cash":4456.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC C MOTOR EVOKED UPPR LIMBS","code_information":[{"code":"Px00074010106","type":"CDM"},{"code":"95928","type":"HCPCS"}],"standard_charges":[{"gross_charge":1326.0,"discounted_cash":464.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC C MOTOR EVOKED LWR LIMBS","code_information":[{"code":"Px00074010107","type":"CDM"},{"code":"95929","type":"HCPCS"}],"standard_charges":[{"gross_charge":1326.0,"discounted_cash":464.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EEG DURING SURGERY","code_information":[{"code":"Px00074010115","type":"CDM"},{"code":"95955","type":"HCPCS"}],"standard_charges":[{"gross_charge":1142.0,"discounted_cash":399.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CHOLANGIOSCOPY","code_information":[{"code":"Px00075010009","type":"CDM"}],"standard_charges":[{"gross_charge":10992.0,"discounted_cash":3847.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY SCREENING","code_information":[{"code":"Px00075010014","type":"CDM"}],"standard_charges":[{"gross_charge":4248.0,"discounted_cash":1486.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/ BIOPSY","code_information":[{"code":"Px00075010015","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/ BLEEDING CONT","code_information":[{"code":"Px00075010016","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EGD BIOPSY SINGLE/MULTIPLE","code_information":[{"code":"Px00075010024","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EGD CONTROL BLEEDING ANY","code_information":[{"code":"Px00075010025","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ENDOSCOPY","code_information":[{"code":"Px00075010030","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ERCP","code_information":[{"code":"Px00075010033","type":"CDM"}],"standard_charges":[{"gross_charge":7929.0,"discounted_cash":2775.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EUS LINEAR","code_information":[{"code":"Px00075010040","type":"CDM"}],"standard_charges":[{"gross_charge":7568.0,"discounted_cash":2648.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EUS RADIAL","code_information":[{"code":"Px00075010041","type":"CDM"}],"standard_charges":[{"gross_charge":7568.0,"discounted_cash":2648.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FLEXIBLE SIGMOIDOSCOPY W/ BIOPOSY","code_information":[{"code":"Px00075010046","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GASTROESOPHAGEAL REFLUX TEST","code_information":[{"code":"Px00075010050","type":"CDM"},{"code":"91034","type":"HCPCS"}],"standard_charges":[{"gross_charge":7764.0,"discounted_cash":2717.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC UNLISTED ENDO PROCEDURE","code_information":[{"code":"Px00075010063","type":"CDM"}],"standard_charges":[{"gross_charge":6360.0,"discounted_cash":2226.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/ BLEEDING CONTROL","code_information":[{"code":"Px00075010074","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC UPPR GI SCOPE W/SUBMUC INJ","code_information":[{"code":"Px00075010084","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EGD W/ ABLATION","code_information":[{"code":"Px00075010085","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EGD VARICES LIGATION","code_information":[{"code":"Px00075010086","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EGD GUIDE WIRE INSERTION","code_information":[{"code":"Px00075010087","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EGD PLACE GASTROSTOMY TUBE","code_information":[{"code":"Px00075010088","type":"CDM"}],"standard_charges":[{"gross_charge":7929.0,"discounted_cash":2775.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CHANGE GASTROSTOMY TUBE","code_information":[{"code":"Px00075010097","type":"CDM"}],"standard_charges":[{"gross_charge":1013.0,"discounted_cash":354.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY POLP/HOT BX","code_information":[{"code":"Px00075010098","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY POLYP SNARE","code_information":[{"code":"Px00075010099","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY THRU STOMA","code_information":[{"code":"Px00075010100","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/ SUBMUC INJ","code_information":[{"code":"Px00075010101","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/ ABLATION","code_information":[{"code":"Px00075010102","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EGD DIAGNOSTIC BRUSH WASH","code_information":[{"code":"Px00075010106","type":"CDM"}],"standard_charges":[{"gross_charge":4451.0,"discounted_cash":1557.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EGD DILATE STRICTURE","code_information":[{"code":"Px00075010107","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESOPH EGD DILATION/LESS THAN 30 MM","code_information":[{"code":"Px00075010108","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ERCP WITH BIOPSY","code_information":[{"code":"Px00075010110","type":"CDM"}],"standard_charges":[{"gross_charge":7568.0,"discounted_cash":2648.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY DX PROCURE","code_information":[{"code":"Px00075010113","type":"CDM"}],"standard_charges":[{"gross_charge":4248.0,"discounted_cash":1486.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/ ABLATION","code_information":[{"code":"Px00075010114","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/ BALLOON DILATION","code_information":[{"code":"Px00075010115","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/ SNARE REMOVAL","code_information":[{"code":"Px00075010118","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ERCP W/ REMOVAL CALCULUS","code_information":[{"code":"Px00075010123","type":"CDM"}],"standard_charges":[{"gross_charge":7568.0,"discounted_cash":2648.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ERCP W/ SPHINCTER/PAPILLO","code_information":[{"code":"Px00075010124","type":"CDM"}],"standard_charges":[{"gross_charge":7568.0,"discounted_cash":2648.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EGD CAUTERY TUMOR POLYP","code_information":[{"code":"Px00075010141","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EGD REMOVE LESION SNARE","code_information":[{"code":"Px00075010142","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ENDO CHOLANGIOPANCREATOGRAPH W/ LITHOTRIPSY","code_information":[{"code":"Px00075010149","type":"CDM"}],"standard_charges":[{"gross_charge":7568.0,"discounted_cash":2648.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DILATE ESOPHAGUS, UNGUIDED","code_information":[{"code":"Px00075010154","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ENDO ULTRSND UGI W/WO FNA","code_information":[{"code":"Px00075010195","type":"CDM"}],"standard_charges":[{"gross_charge":7568.0,"discounted_cash":2648.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/DILATION","code_information":[{"code":"Px00075010210","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCOPY RIGID TRNSO DX","code_information":[{"code":"Px00075010219","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCP RIG TRNSO INJECT","code_information":[{"code":"Px00075010220","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCP RIG TRNSO BIOPSY","code_information":[{"code":"Px00075010221","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCP RIG TRNSO REM FB","code_information":[{"code":"Px00075010222","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCOPY RIGID BALLOON","code_information":[{"code":"Px00075010223","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCP GUIDE WIRE DILAT","code_information":[{"code":"Px00075010224","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCOPY FLEX DX BRUSH","code_information":[{"code":"Px00075010225","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSC FLEX TRNSN BIOPSY","code_information":[{"code":"Px00075010226","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCOP MUCOSAL RESECT","code_information":[{"code":"Px00075010227","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCOP STENT PLACEMENT","code_information":[{"code":"Px00075010228","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCOPY RETRO BALLOON","code_information":[{"code":"Px00075010229","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSC DILATE BALLOON 30","code_information":[{"code":"Px00075010230","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCOPY LESION ABLATE","code_information":[{"code":"Px00075010231","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EGD BALLOON DIL ESOPH30 MM/>","code_information":[{"code":"Px00075010232","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EGD US TRANSMURAL INJXN/MARK","code_information":[{"code":"Px00075010233","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EGD ENDO MUCOSAL RESECTION","code_information":[{"code":"Px00075010234","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EGD ENDOSCOPIC STENT PLACE","code_information":[{"code":"Px00075010235","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EGD LESION ABLATION","code_information":[{"code":"Px00075010236","type":"CDM"}],"standard_charges":[{"gross_charge":5240.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ERCP DUCT STENT PLACEMENT","code_information":[{"code":"Px00075010237","type":"CDM"}],"standard_charges":[{"gross_charge":7568.0,"discounted_cash":2648.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ERCP REMOVE FORGN BODY DUCT","code_information":[{"code":"Px00075010238","type":"CDM"}],"standard_charges":[{"gross_charge":7568.0,"discounted_cash":2648.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ERCP STENT EXCHANGE W/DILATE","code_information":[{"code":"Px00075010239","type":"CDM"}],"standard_charges":[{"gross_charge":7568.0,"discounted_cash":2648.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ERCP EA DUCT/AMPULLA DILATE","code_information":[{"code":"Px00075010240","type":"CDM"}],"standard_charges":[{"gross_charge":7568.0,"discounted_cash":2648.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ERCP LESION ABLATE W/DILATE","code_information":[{"code":"Px00075010241","type":"CDM"}],"standard_charges":[{"gross_charge":7568.0,"discounted_cash":2648.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SMALL BOWEL ENDOSCOPY W STENT PLCMNT","code_information":[{"code":"Px00075010246","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY WITH ABLATION THROUGH STOMA","code_information":[{"code":"Px00075010247","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/STENT PLCMT THROUGH STOMA","code_information":[{"code":"Px00075010248","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/RESECTION","code_information":[{"code":"Px00075010249","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/INJECTION","code_information":[{"code":"Px00075010250","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/DILATION","code_information":[{"code":"Px00075010251","type":"CDM"}],"standard_charges":[{"gross_charge":4989.0,"discounted_cash":1746.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/ULTRASOUND","code_information":[{"code":"Px00075010252","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/NDL ASPIR/BX","code_information":[{"code":"Px00075010253","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/DECOMPRESSION THROUGH STOMA","code_information":[{"code":"Px00075010254","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/ABLATION","code_information":[{"code":"Px00075010255","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/PLCMT STENT","code_information":[{"code":"Px00075010256","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/RESECTION","code_information":[{"code":"Px00075010257","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SGMDSC W/BAND LIGATION","code_information":[{"code":"Px00075010258","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/ABLATION","code_information":[{"code":"Px00075010259","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/STENT PLCMT","code_information":[{"code":"Px00075010260","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/RESECTION THROUGH STOMA","code_information":[{"code":"Px00075010261","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/DECOMPRESSION","code_information":[{"code":"Px00075010262","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/BAND LIGATION","code_information":[{"code":"Px00075010263","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC UNLISTED PROCEDURE COLON","code_information":[{"code":"Px00075010264","type":"CDM"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":1921.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 6","code_information":[{"code":"Px00075010272","type":"CDM"}],"standard_charges":[{"gross_charge":19488.0,"discounted_cash":6820.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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: JV CPCT LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 2","code_information":[{"code":"Px00075010316","type":"CDM"}],"standard_charges":[{"gross_charge":4868.0,"discounted_cash":1703.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 3","code_information":[{"code":"Px00075010317","type":"CDM"}],"standard_charges":[{"gross_charge":9201.0,"discounted_cash":3220.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 4","code_information":[{"code":"Px00075010318","type":"CDM"}],"standard_charges":[{"gross_charge":11360.0,"discounted_cash":3976.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 5","code_information":[{"code":"Px00075010319","type":"CDM"}],"standard_charges":[{"gross_charge":15781.0,"discounted_cash":5523.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":976.0,"discounted_cash":341.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1945.0,"discounted_cash":680.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2918.0,"discounted_cash":1021.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3880.0,"discounted_cash":1358.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4845.0,"discounted_cash":1695.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INCISION & DRAINAGE PILONIDAL CYST COMPLICATED  CDM","code_information":[{"code":"Px00076100081","type":"CDM"},{"code":"10081","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":597.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC HRIF ESTAB PT VISIT - LEVEL 1","code_information":[{"code":"Px00076100086","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":16.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC AUTOLOG PRP DIAB WOUND ULCER PER TREATMENT CDM","code_information":[{"code":"Px00076100245","type":"CDM"},{"code":"G0465","type":"HCPCS"}],"standard_charges":[{"gross_charge":8135.0,"discounted_cash":2847.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 2","code_information":[{"code":"Px00076110002","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 3","code_information":[{"code":"Px00076110003","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":807.0,"discounted_cash":282.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 4","code_information":[{"code":"Px00076110004","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":965.0,"discounted_cash":337.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 5","code_information":[{"code":"Px00076110005","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":1288.0,"discounted_cash":450.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 1","code_information":[{"code":"Px00076110006","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 5","code_information":[{"code":"Px00076110021","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":867.0,"discounted_cash":303.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 2","code_information":[{"code":"Px00076110039","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":173.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 3","code_information":[{"code":"Px00076110040","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.0,"discounted_cash":195.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 4","code_information":[{"code":"Px00076110041","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":217.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","code_information":[{"code":"Px00076110076","type":"CDM"},{"code":"11046","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","code_information":[{"code":"Px00076110078","type":"CDM"},{"code":"11047","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","code_information":[{"code":"Px00076110085","type":"CDM"},{"code":"11732","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA","code_information":[{"code":"Px00076110096","type":"CDM"},{"code":"59871","type":"HCPCS"}],"standard_charges":[{"gross_charge":10205.0,"discounted_cash":3571.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DEBRIDE/DRESS SMALL BURN LT 5 TBSA","code_information":[{"code":"Px00076110177","type":"CDM"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INSTILL BLADDER ANTICARCINOGENIC AGENT CDM","code_information":[{"code":"Px00076110205","type":"CDM"},{"code":"51720","type":"HCPCS"}],"standard_charges":[{"gross_charge":2968.0,"discounted_cash":1038.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INJECTION AA&/STRD BRACH PLEX CONT NFS CATH IMG CDM","code_information":[{"code":"Px00076110208","type":"CDM"},{"code":"64416","type":"HCPCS"}],"standard_charges":[{"gross_charge":4551.0,"discounted_cash":1592.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GRAFT TRUNK/ARM/LEG TOTAL TO 100 SQCM 1ST 25 SQCM","code_information":[{"code":"Px00076110220","type":"CDM"},{"code":"15271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1930.0,"discounted_cash":675.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GRAFT TRUNK/ARM/LEG TOTAL TO 100 SQ/CM EA ADDL 25 SQCM","code_information":[{"code":"Px00076110221","type":"CDM"},{"code":"15272","type":"HCPCS"}],"standard_charges":[{"gross_charge":1290.0,"discounted_cash":451.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GRAFT TRUNK/ARM/LEG TOTAL > 100 SQ CM 1ST 100 SQ CM","code_information":[{"code":"Px00076110222","type":"CDM"},{"code":"15273","type":"HCPCS"}],"standard_charges":[{"gross_charge":11260.0,"discounted_cash":3941.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC GRAFT TRUNK/ARM/LEG TOTAL > 100 SQ CM EA ADDL 100 SQ CM","code_information":[{"code":"Px00076110223","type":"CDM"},{"code":"15274","type":"HCPCS"}],"standard_charges":[{"gross_charge":1930.0,"discounted_cash":675.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FACE/NECK/HAND/FEET/GENITALIA TOTAL TO 100 SQ CM 1ST 25 SQ CM","code_information":[{"code":"Px00076110224","type":"CDM"},{"code":"15275","type":"HCPCS"}],"standard_charges":[{"gross_charge":1930.0,"discounted_cash":675.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FACE/NECK/HAND/FEET/GENITALIA TOTAL TO 100 SQ CM EA ADDL 25 SQ CM","code_information":[{"code":"Px00076110225","type":"CDM"},{"code":"15276","type":"HCPCS"}],"standard_charges":[{"gross_charge":805.0,"discounted_cash":281.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FACE/NECK/HAND/FEET/GENITALIA TOTAL > 100 SQ CM 1ST 100 SQ CM","code_information":[{"code":"Px00076110226","type":"CDM"},{"code":"15277","type":"HCPCS"}],"standard_charges":[{"gross_charge":8044.0,"discounted_cash":2815.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FACE/NECK/HAND/FEET/GENITALIA TOTAL > 100 SQ CM EA ADDL 100 SQ CM","code_information":[{"code":"Px00076110227","type":"CDM"},{"code":"15278","type":"HCPCS"}],"standard_charges":[{"gross_charge":1290.0,"discounted_cash":451.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":528.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":268.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SKIN SPLT GRFT TRNK/ARM/LEG","code_information":[{"code":"Px00076110260","type":"CDM"},{"code":"15100","type":"HCPCS"}],"standard_charges":[{"gross_charge":5811.0,"discounted_cash":2033.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC EXCISION SACRAL PRESSURE ULCER W/PRIMARY SUTURE","code_information":[{"code":"Px00076110262","type":"CDM"},{"code":"15931","type":"HCPCS"}],"standard_charges":[{"gross_charge":12448.0,"discounted_cash":4356.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DEBRIDE BONE LTE 20 SQ CM","code_information":[{"code":"Px00076110286","type":"CDM"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":2545.0,"discounted_cash":890.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DEBRIDE MUSCLE/FASCIA LTE 20 SQ CM","code_information":[{"code":"Px00076110287","type":"CDM"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":871.0,"discounted_cash":304.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CIRCUMCISION NEONATE","code_information":[{"code":"Px00076110291","type":"CDM"},{"code":"54160","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":397.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IRRIGATION IMPLANTED VAD","code_information":[{"code":"Px00076110307","type":"CDM"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.0,"discounted_cash":154.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DEBRIDEMENT NAIL ANY METHOD 1-5 CDM","code_information":[{"code":"Px00076110453","type":"CDM"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DEBRIDEMENT NAIL ANY METHOD 6/GT CDM","code_information":[{"code":"Px00076110454","type":"CDM"},{"code":"11721","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":787.0,"discounted_cash":275.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 CDM","code_information":[{"code":"Px00076110459","type":"CDM"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CHEMICAL CAUTERIZATION OF GRANULATION TISSUE CDM","code_information":[{"code":"Px00076110460","type":"CDM"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":976.0,"discounted_cash":341.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1945.0,"discounted_cash":680.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2918.0,"discounted_cash":1021.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3880.0,"discounted_cash":1358.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4845.0,"discounted_cash":1695.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC HOSPITAL OBSERVATION PER HR CDM","code_information":[{"code":"Px00076210001","type":"CDM"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":81.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1486.0,"discounted_cash":520.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":74.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IMMUNIZATION ADMIN CDM","code_information":[{"code":"Px00077110001","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC IMMUNIZATION ADMIN EACH ADD CDM","code_information":[{"code":"Px00077110002","type":"CDM"},{"code":"90472","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ADMIN INFLUENZA VIRUS VAC CDM","code_information":[{"code":"Px00077110003","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ADMIN PNEUMOCOCCAL VACCINE CDM","code_information":[{"code":"Px00077110004","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ADMIN HEPATITIS B VACCINE CDM","code_information":[{"code":"Px00077110005","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC HEMODIALYSIS IP","code_information":[{"code":"Px00080110006","type":"CDM"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":2905.0,"discounted_cash":1016.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CAPD IP","code_information":[{"code":"Px00080310002","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":6707.0,"discounted_cash":2347.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CCPD IP","code_information":[{"code":"Px00080410001","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":6707.0,"discounted_cash":2347.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CRRT IP","code_information":[{"code":"Px00080900001","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":6707.0,"discounted_cash":2347.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2905.0,"discounted_cash":1016.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC HEMODIAL OP ER/POSTOP ESRD","code_information":[{"code":"Px00082910001","type":"CDM"},{"code":"G0257","type":"HCPCS"}],"standard_charges":[{"gross_charge":2844.0,"discounted_cash":995.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CAPD OP","code_information":[{"code":"Px00084110001","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":6707.0,"discounted_cash":2347.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CCPD OP","code_information":[{"code":"Px00085100001","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":6707.0,"discounted_cash":2347.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DEVELPMNTL TEST ADMIN QHP 1ST HR CDM","code_information":[{"code":"Px00091810034","type":"CDM"},{"code":"96112","type":"HCPCS"}],"standard_charges":[{"gross_charge":1323.0,"discounted_cash":463.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN CDM","code_information":[{"code":"Px00091810035","type":"CDM"},{"code":"96113","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FETAL NON-STRESS TEST CDM","code_information":[{"code":"Px00092010032","type":"CDM"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":142.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC FETAL CONTRACT STRESS TEST","code_information":[{"code":"Px00092010033","type":"CDM"},{"code":"59020","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":72.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4619.0,"discounted_cash":1616.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3465.0,"discounted_cash":1212.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1524.0,"discounted_cash":533.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1379.0,"discounted_cash":482.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4009.0,"discounted_cash":1403.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3281.0,"discounted_cash":1148.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3147.0,"discounted_cash":1101.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2072.0,"discounted_cash":725.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3177.0,"discounted_cash":1111.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2218.0,"discounted_cash":776.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2982.0,"discounted_cash":1043.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2121.0,"discounted_cash":742.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2040.0,"discounted_cash":714.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD","code_information":[{"code":"Px00092110020","type":"CDM"},{"code":"93979","type":"HCPCS"}],"standard_charges":[{"gross_charge":1667.0,"discounted_cash":583.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC PENILE VASCULAR STUDY COMPLETE","code_information":[{"code":"Px00092110021","type":"CDM"},{"code":"93980","type":"HCPCS"}],"standard_charges":[{"gross_charge":2121.0,"discounted_cash":742.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC DUPLEX SCAN HEMODIALYSIS ACCESS","code_information":[{"code":"Px00092110024","type":"CDM"},{"code":"93990","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":217.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1124.0,"discounted_cash":393.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC ART PRESSURE WAVEFORM ANALYS","code_information":[{"code":"Px00092110070","type":"CDM"},{"code":"93050","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":2185.0,"discounted_cash":764.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":3271.0,"discounted_cash":1144.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":4885.0,"discounted_cash":1709.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SOMATOSENSORY TESTING UPPER LIMBS","code_information":[{"code":"Px00092210013","type":"CDM"},{"code":"95925","type":"HCPCS"}],"standard_charges":[{"gross_charge":1335.0,"discounted_cash":467.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC SOMATOSENSORY TESTING LOWER LIMBS","code_information":[{"code":"Px00092210018","type":"CDM"},{"code":"95926","type":"HCPCS"}],"standard_charges":[{"gross_charge":1335.0,"discounted_cash":467.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC NEUROMUSCULAR JUNCTION TEST","code_information":[{"code":"Px00092210023","type":"CDM"},{"code":"95937","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INSERT STRAIGHT CATH BLADDER","code_information":[{"code":"Px00094010050","type":"CDM"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":171.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1076.0,"discounted_cash":376.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC THERAPUTIC PHLEBOTOMY","code_information":[{"code":"Px00094010204","type":"CDM"},{"code":"99195","type":"HCPCS"}],"standard_charges":[{"gross_charge":1587.0,"discounted_cash":555.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC INJ SQ OR IM CDM","code_information":[{"code":"Px00094010205","type":"CDM"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":71.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":1076.0,"discounted_cash":376.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":220.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":182.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":260.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":169.0,"discounted_cash":59.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT 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":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"description":"HC CARDIAC REHAB/MONITOR PHASE 2","code_information":[{"code":"Px00094310023","type":"CDM"},{"code":"93798","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JV CPCT LOCATION (Unit Price)"}]},{"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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE LIQUID 4 MEQ/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000000025","type":"CDM"},{"code":"00000000025","type":"NDC"}],"standard_charges":[{"gross_charge":4.81,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LANSOPRAZOLE 3 MG/ML SUSPENSION","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000000054","type":"CDM"},{"code":"00000000054","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMINO ACIDS 3%-D10W-CALCIUM GLUCONATE 400 MG/200 ML INFUSION","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00000000089","type":"CDM"},{"code":"00000000089","type":"NDC"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMINO ACIDS 3%-HEPARIN 0.5 UNIT/ML INFUSION","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000000090","type":"CDM"},{"code":"00000000090","type":"NDC"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PENICILLIN G POTASSIUM 5 MILLION UNITS IN SODIUM CHLORIDE 0.9% 100 ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000000099","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00000000099","type":"NDC"}],"standard_charges":[{"gross_charge":242.48,"discounted_cash":84.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMINO ACIDS 3%-D10W-CALCIUM GLUCONATE 2 MG/ML-HEPARIN 0.5 UNIT/ML INFUSION","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00000000160","type":"CDM"},{"code":"00000000160","type":"NDC"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OSELTAMIVIR 15 MG/ML SUSPENSION","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000000268","type":"CDM"},{"code":"00000000268","type":"NDC"}],"standard_charges":[{"gross_charge":9.9,"discounted_cash":3.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFOTAXIME 100 MG/ML IV SYRINGE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000306","type":"CDM"},{"code":"J0698","type":"HCPCS"},{"code":"00000000306","type":"NDC"}],"standard_charges":[{"gross_charge":94.53,"discounted_cash":33.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFOTAXIME 100 MG/ML IV SYRINGE","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000000307","type":"CDM"},{"code":"J0698","type":"HCPCS"},{"code":"00000000307","type":"NDC"}],"standard_charges":[{"gross_charge":95.81,"discounted_cash":33.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEFOXITIN 100 MG/ML IV SYRINGE","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000000311","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"00000000311","type":"NDC"}],"standard_charges":[{"gross_charge":101.09,"discounted_cash":35.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE INJ 4 MG/ML,MORPHINE SULFATE INJ PF 4 MG/ML,MORPHINE SULFATE IV SOLN PF 4 MG/ML,MORPHINE SULFATE IV SOLN 4 MG/ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000338","type":"CDM"},{"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: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE INJ 4 MG/ML,MORPHINE SULFATE INJ PF 4 MG/ML,MORPHINE SULFATE IV SOLN PF 4 MG/ML,MORPHINE SULFATE IV SOLN 4 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MITOMYCIN 0.4 MG/ML FOR TOPICAL APPLICATION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000356","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"00000000356","type":"NDC"}],"standard_charges":[{"gross_charge":51.96,"discounted_cash":18.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXYCODONE HCL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000000405","type":"CDM"},{"code":"00000000405","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMIODARONE 150 MG IN 100 ML D5W IVPB ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000000409","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"00000000409","type":"NDC"}],"standard_charges":[{"gross_charge":242.1,"discounted_cash":84.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":20.0,"type":"ML"},"code_information":[{"code":"Rx00000000453","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00000000453","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000000468","type":"CDM"},{"code":"00000000468","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROMORPHONE 200 MCG/ML PCA","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000000528","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00000000528","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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":30.0,"type":"ML"},"code_information":[{"code":"Rx00000000554","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00000000554","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL ADD-A-VIAL SIMPLE 750 MG (BASE EQUIVALENT)","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000000567","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00000000567","type":"NDC"}],"standard_charges":[{"gross_charge":242.84,"discounted_cash":84.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000000901","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"00000000901","type":"NDC"}],"standard_charges":[{"gross_charge":29.49,"discounted_cash":10.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 5 MG/ML,MORPHINE SULFATE-NACL SOLN PREF SYR 150 MG/30ML-0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000000952","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00000000952","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE (CYTOXAN) 10 MG/ML ORAL SUSPENSION (PEDS)","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00000000991","type":"CDM"},{"code":"J8530","type":"HCPCS"},{"code":"00000000991","type":"NDC"}],"standard_charges":[{"gross_charge":1505.7,"discounted_cash":527.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ON-Q PUMP BAG 2 ML/HR (SINGLE LUMEN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001139","type":"CDM"},{"code":"C9804","type":"HCPCS"},{"code":"00000001139","type":"NDC"}],"standard_charges":[{"gross_charge":212.28,"discounted_cash":74.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXEPIN HCL CONC 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000001156","type":"CDM"},{"code":"00000001156","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXEPIN HCL CONC 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000001157","type":"CDM"},{"code":"00000001157","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00000001160","type":"CDM"},{"code":"00000001160","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CITRATE IV SOLN PREFILLED SYRINGE 4%,SODIUM CITRATE LOCK FLUSH IV SOLN PREF SYR 120 MG/3ML (4%),SODIUM CITRATE SOLN PREFILLED SYRINGE 4%,SODIUM CITRATE LOCK FLUSH IV SOLN 4%,ANTICOAGULANT SODIUM CITRATE SOLN 4%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00000001204","type":"CDM"},{"code":"00000001204","type":"NDC"}],"standard_charges":[{"gross_charge":93.32,"discounted_cash":32.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CITRATE IV SOLN PREFILLED SYRINGE 4%,SODIUM CITRATE LOCK FLUSH IV SOLN PREF SYR 120 MG/3ML (4%),SODIUM CITRATE SOLN PREFILLED SYRINGE 4%,SODIUM CITRATE LOCK FLUSH IV SOLN 4%,ANTICOAGULANT SODIUM CITRATE SOLN 4%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00000001205","type":"CDM"},{"code":"00000001205","type":"NDC"}],"standard_charges":[{"gross_charge":93.32,"discounted_cash":32.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 500 UNIT/500ML-0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000001251","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00000001251","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLONAZEPAM TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001252","type":"CDM"},{"code":"00000001252","type":"NDC"}],"standard_charges":[{"gross_charge":3.4,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00000001279","type":"CDM"},{"code":"00000001279","type":"NDC"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":73.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHYTONADIONE 10 MG/ML PO SOLN (FROM INJ)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000001291","type":"CDM"},{"code":"00000001291","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00000001313","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"00000001313","type":"NDC"}],"standard_charges":[{"gross_charge":93.52,"discounted_cash":32.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXAMETHASONE 4 MG/ML SYRINGE FOR NEBULIZATION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000001412","type":"CDM"},{"code":"00000001412","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOBRAMYCIN SULFATE INJ 80 MG/2ML (40 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000001456","type":"CDM"},{"code":"J3260","type":"HCPCS"},{"code":"00000001456","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METRONIDAZOLE BENZOATE FOR SUSP 50 MG/ML (CMPD KIT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000001502","type":"CDM"},{"code":"00000001502","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METRONIDAZOLE BENZOATE FOR SUSP 50 MG/ML (CMPD KIT)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000001503","type":"CDM"},{"code":"00000001503","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIPHENHYD-LIDOCAINE-AL HYDROXIDE-MG HYDROXIDE-SIMETH","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000001521","type":"CDM"},{"code":"00000001521","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MISOPROSTOL 50 MCG PO TABS (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001526","type":"CDM"},{"code":"00000001526","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | NDC EA = 50 MCG"}]},{"description":"AMPICILLIN SODIUM FOR INJ","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000001527","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00000001527","type":"NDC"}],"standard_charges":[{"gross_charge":94.25,"discounted_cash":32.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL-SODIUM CHLORIDE IV SOLN 1 GM/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000001547","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"00000001547","type":"NDC"}],"standard_charges":[{"gross_charge":245.19,"discounted_cash":85.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PENICILLIN G POTASSIUM 5 MILLION UNITS IN NS 100 ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000001564","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00000001564","type":"NDC"}],"standard_charges":[{"gross_charge":245.02,"discounted_cash":85.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 0.9% IV SOLN 30 UNIT/500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000001566","type":"CDM"},{"code":"00000001566","type":"NDC"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GENTAMICIN 80 MG IN 1000 ML NS IRRIGATION BAG ONE STEP","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000001624","type":"CDM"},{"code":"00000001624","type":"NDC"}],"standard_charges":[{"gross_charge":97.51,"discounted_cash":34.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"1:1 RATIO LIDOCAINE 2% + EPI (1:100,000) + BUPIVACAINE 0.75% + HYALURONIDASE 150 UNITS","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000001692","type":"CDM"},{"code":"00000001692","type":"NDC"}],"standard_charges":[{"gross_charge":215.26,"discounted_cash":75.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00000001749","type":"CDM"},{"code":"00000001749","type":"NDC"}],"standard_charges":[{"gross_charge":294.97,"discounted_cash":103.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"1:1 BUPIVACAINE 0.5% W/ LIDOCAINE 1%-EPI 1:100000 AND BICARB 1 ML","drug_information":{"unit":101.0,"type":"ML"},"code_information":[{"code":"Rx00000001780","type":"CDM"},{"code":"00000001780","type":"NDC"}],"standard_charges":[{"gross_charge":118.6,"discounted_cash":41.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE IV SOLN 250 MG/50ML (BASE EQ)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000001825","type":"CDM"},{"code":"J0583","type":"HCPCS"},{"code":"00000001825","type":"NDC"}],"standard_charges":[{"gross_charge":2736.44,"discounted_cash":957.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMINOCAPROIC ACID 10 G IN NS 90 ML INFUSION ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000001844","type":"CDM"},{"code":"00000001844","type":"NDC"}],"standard_charges":[{"gross_charge":245.3,"discounted_cash":85.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BIVALIRUDIN 200 MG/100 ML (VASC ANESTH) ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000001845","type":"CDM"},{"code":"J0583","type":"HCPCS"},{"code":"00000001845","type":"NDC"}],"standard_charges":[{"gross_charge":6015.15,"discounted_cash":2105.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FLORBETAPIR F-18 (AMYVID)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001864","type":"CDM"},{"code":"A9586","type":"HCPCS"},{"code":"00000001864","type":"NDC"}],"standard_charges":[{"gross_charge":7104.0,"discounted_cash":2486.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | NDC EA = 10 MILLICURIE"}]},{"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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEFAZOLIN 100MG/0.5 ML + DEXAMETHASONE 2MG/0.5ML INTRAOCULAR P","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000001876","type":"CDM"},{"code":"00000001876","type":"NDC"}],"standard_charges":[{"gross_charge":98.25,"discounted_cash":34.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMINO ACID INFUSION 3% IN D10W","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000001907","type":"CDM"},{"code":"00000001907","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEECH","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001924","type":"CDM"},{"code":"00000001924","type":"NDC"}],"standard_charges":[{"gross_charge":25.72,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCORTISONE 0.5 MG/ML INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001977","type":"CDM"},{"code":"J1720","type":"HCPCS"},{"code":"00000001977","type":"NDC"}],"standard_charges":[{"gross_charge":93.26,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN ORAL SOLN 250 MG/5ML","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx00000002039","type":"CDM"},{"code":"00000002039","type":"NDC"}],"standard_charges":[{"gross_charge":30.24,"discounted_cash":10.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL SOLN 5 MG/5ML (10 MG/10ML) (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000002040","type":"CDM"},{"code":"00000002040","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ADENOSINE 1 MG/ML IN NS 90 ML - ONE STEP","drug_information":{"unit":90.0,"type":"ML"},"code_information":[{"code":"Rx00000002136","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"00000002136","type":"NDC"}],"standard_charges":[{"gross_charge":1058.73,"discounted_cash":370.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.125% IN NS INJECTION - ONE STEP","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx00000002141","type":"CDM"},{"code":"00000002141","type":"NDC"}],"standard_charges":[{"gross_charge":246.92,"discounted_cash":86.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EPINEPHRINE 1:1000 1 ML IN 1000 ML NS IRRIGATION ONE STEP","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000002146","type":"CDM"},{"code":"00000002146","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENTANYL 10 MCG/ML INFUSION (NICU 20 ML SYRINGE)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000002187","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00000002187","type":"NDC"}],"standard_charges":[{"gross_charge":211.97,"discounted_cash":74.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 60 MG/30ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000002190","type":"CDM"},{"code":"00000002190","type":"NDC"}],"standard_charges":[{"gross_charge":418.06,"discounted_cash":146.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METRONIDAZOLE 250 MG/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000002194","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00000002194","type":"NDC"}],"standard_charges":[{"gross_charge":241.1,"discounted_cash":84.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000002196","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00000002196","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000002197","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00000002197","type":"NDC"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 20 MEQ/50ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000002212","type":"CDM"},{"code":"00000002212","type":"NDC"}],"standard_charges":[{"gross_charge":241.53,"discounted_cash":84.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL-SODIUM CHLORIDE IV SOLN 1.25 GM/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000002214","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"00000002214","type":"NDC"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00000002307","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"00000002307","type":"NDC"}],"standard_charges":[{"gross_charge":93.94,"discounted_cash":32.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENTANYL 5 MCG/ML + ROPIVACAINE 0.1% IN NS EPIDURAL (PREMIX)","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000002372","type":"CDM"},{"code":"00000002372","type":"NDC"}],"standard_charges":[{"gross_charge":767.0,"discounted_cash":268.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.0625% AND FENTANYL 2 MCG/ML EPIDURAL,FENTANYL 0.5 MG/250ML-BUPIV 0.0625%-NACL 0.9% PF EPIDUR INJ,FENTANYL 0.2 MG/100ML-BUPIV 0.0625%-NACL 0.9% EPIDURAL INJ","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00000002417","type":"CDM"},{"code":"00000002417","type":"NDC"}],"standard_charges":[{"gross_charge":171.8,"discounted_cash":60.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TRANEXAMIC ACID ADD-A-VIAL SIMPLE 1000 MG","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx00000002503","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"00000002503","type":"NDC"}],"standard_charges":[{"gross_charge":895.75,"discounted_cash":313.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL 5 MG/ML IV SYRINGE","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000002608","type":"CDM"},{"code":"00000002608","type":"NDC"}],"standard_charges":[{"gross_charge":93.82,"discounted_cash":32.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM POLYSTYRENE SULFONATE SUSP 15 GM/60ML","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx00000002613","type":"CDM"},{"code":"00000002613","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"STUDY-CAPLACIZUMAB 10 MG/ML INJECTION (COMPASSIONATE USE)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000002678","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000002678","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0035,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 5 MG/ML,MORPHINE SULFATE-NACL SOLN PREF SYR 150 MG/30ML-0.9%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000002856","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00000002856","type":"NDC"}],"standard_charges":[{"gross_charge":164.67,"discounted_cash":57.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NITROGLYCERIN IV SOLN 200 MCG/ML IN D5W","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00000002879","type":"CDM"},{"code":"J2305","type":"HCPCS"},{"code":"00000002879","type":"NDC"}],"standard_charges":[{"gross_charge":94.35,"discounted_cash":33.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIGOXIN ORAL SOLN 0.05 MG/ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx00000002915","type":"CDM"},{"code":"00000002915","type":"NDC"}],"standard_charges":[{"gross_charge":3.68,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMIKACIN 0.4 MG/0.1 ML IN 0.9% NACL (PF)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003184","type":"CDM"},{"code":"J0278","type":"HCPCS"},{"code":"00000003184","type":"NDC"}],"standard_charges":[{"gross_charge":96.14,"discounted_cash":33.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPHOTERICIN B 0.005 MG/0.1 ML IN 0.9 % NACL (PF)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003185","type":"CDM"},{"code":"J0285","type":"HCPCS"},{"code":"00000003185","type":"NDC"}],"standard_charges":[{"gross_charge":157.24,"discounted_cash":55.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN 1 MG/0.1 ML IN 0.9 % NACL (PF)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003189","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00000003189","type":"NDC"}],"standard_charges":[{"gross_charge":95.21,"discounted_cash":33.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CLOPIDOGREL 5 MG/ML ORAL SOLUTION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003198","type":"CDM"},{"code":"00000003198","type":"NDC"}],"standard_charges":[{"gross_charge":9.04,"discounted_cash":3.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NOREPINEPHRINE-DEXTROSE IV SOLUTION 4 MG/250ML-5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000003246","type":"CDM"},{"code":"00000003246","type":"NDC"}],"standard_charges":[{"gross_charge":243.37,"discounted_cash":85.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMIODARONE 900 MG IN 500 ML D5W INFUSION ONE STEP","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000003249","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"00000003249","type":"NDC"}],"standard_charges":[{"gross_charge":245.08,"discounted_cash":85.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMIODARONE 150 MG IN 100 ML D5W IVPB ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000003251","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"00000003251","type":"NDC"}],"standard_charges":[{"gross_charge":863.04,"discounted_cash":302.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BETAMETHASONE 6 MG WITH 1 ML NS INJECTION ONE STEP","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000003263","type":"CDM"},{"code":"J0702","type":"HCPCS"},{"code":"00000003263","type":"NDC"}],"standard_charges":[{"gross_charge":99.67,"discounted_cash":34.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METHADONE HCL SOLN 10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000003296","type":"CDM"},{"code":"00000003296","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCODONE BITART-HOMATROPINE METHYLBROM SOLN 5-1.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000003298","type":"CDM"},{"code":"00000003298","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003352","type":"CDM"},{"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: JVCPCT 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":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: JVCPCT LOCATION"}]},{"description":"HYDROCODONE BITART-HOMATROPINE METHYLBROM SOLN 5-1.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000003358","type":"CDM"},{"code":"00000003358","type":"NDC"}],"standard_charges":[{"gross_charge":3.92,"discounted_cash":1.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 5 UNIT/ML-0.9%,HEPARIN SOD (PORCINE) IN NACL IV SOLN 5000 UNIT/L-0.9%,HEPARIN SOD (PORCINE)-NACL IV SOLN 1250 UNIT/250ML-0.9%,HEPARIN SOD (PORCINE) IN NACL IV SOLN 2500 UNIT/500ML-0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000003379","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00000003379","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OPIUM TINCTURE 1% (10 MG/ML) (MORPHINE EQUIV)","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx00000003405","type":"CDM"},{"code":"00000003405","type":"NDC"}],"standard_charges":[{"gross_charge":2.87,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SUCRALFATE SUSP 1 GM/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000003424","type":"CDM"},{"code":"00000003424","type":"NDC"}],"standard_charges":[{"gross_charge":3.37,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMINOCAPROIC ACID 10 G IN 100 ML NS IVPB ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000003501","type":"CDM"},{"code":"00000003501","type":"NDC"}],"standard_charges":[{"gross_charge":244.18,"discounted_cash":85.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMINOCAPROIC ACID 10 G IN 100 ML NS INFUSION ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000003502","type":"CDM"},{"code":"00000003502","type":"NDC"}],"standard_charges":[{"gross_charge":244.2,"discounted_cash":85.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXMEDETOMIDINE 200 MCG/50 ML NS INFUSION ONE STEP","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000003504","type":"CDM"},{"code":"00000003504","type":"NDC"}],"standard_charges":[{"gross_charge":751.09,"discounted_cash":262.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NOREPINEPHRINE-DEXTROSE IV SOLUTION 16 MG/500ML-5%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000003515","type":"CDM"},{"code":"00000003515","type":"NDC"}],"standard_charges":[{"gross_charge":100.6,"discounted_cash":35.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NOREPINEPHRINE-DEXTROSE 8-5 MG/500ML-% IV SOLN ONE STEP","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000003516","type":"CDM"},{"code":"00000003516","type":"NDC"}],"standard_charges":[{"gross_charge":102.1,"discounted_cash":35.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"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: JVCPCT LOCATION"}]},{"description":"AZATHIOPRINE 50 MG/ML ORAL SUSPENSION","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000003558","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"00000003558","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OPIUM TINCTURE 1% (10 MG/ML) (MORPHINE EQUIV)","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx00000003608","type":"CDM"},{"code":"00000003608","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFTAZIDIME MINIBAG SIMPLE 2 GM","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000003625","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00000003625","type":"NDC"}],"standard_charges":[{"gross_charge":260.74,"discounted_cash":91.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 20%","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00000003723","type":"CDM"},{"code":"J7604","type":"HCPCS"},{"code":"00000003723","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PENICILLIN G POTASSIUM MINIBAG SIMPLE 5000000 UNIT","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000003753","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00000003753","type":"NDC"}],"standard_charges":[{"gross_charge":243.29,"discounted_cash":85.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPICILLIN SODIUM MINIBAG SIMPLE 2 GM","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000003767","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00000003767","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00000003790","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00000003790","type":"NDC"}],"standard_charges":[{"gross_charge":289.6,"discounted_cash":101.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE 1% 20ML + EPINEPHRINE (1:1000) 1ML IN NS 1000 ML ONE STEP","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000003809","type":"CDM"},{"code":"00000003809","type":"NDC"}],"standard_charges":[{"gross_charge":1556.8,"discounted_cash":544.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUORESCEIN 1MG STRIP WITH EPINEPHRINE (1:1000)1ML ONE STEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003811","type":"CDM"},{"code":"00000003811","type":"NDC"}],"standard_charges":[{"gross_charge":93.57,"discounted_cash":32.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | NDC EA = 1 STRIP"}]},{"description":"PREDNISOLONE SOD PHOSPHATE ORAL SOLN 15 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000003818","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"00000003818","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD MINIBAG SIMPLE 2.25 GM (2-0.25 GM)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000003898","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00000003898","type":"NDC"}],"standard_charges":[{"gross_charge":248.95,"discounted_cash":87.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000003904","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00000003904","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETAMINE 100 MG/ML PO SOLUTION","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00000003963","type":"CDM"},{"code":"00000003963","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PHENYTOIN SUSP 125 MG/5ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00000003989","type":"CDM"},{"code":"00000003989","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00000003992","type":"CDM"},{"code":"00000003992","type":"NDC"}],"standard_charges":[{"gross_charge":5.45,"discounted_cash":1.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000004018","type":"CDM"},{"code":"00000004018","type":"NDC"}],"standard_charges":[{"gross_charge":93.31,"discounted_cash":32.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00000004019","type":"CDM"},{"code":"00000004019","type":"NDC"}],"standard_charges":[{"gross_charge":93.69,"discounted_cash":32.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ","drug_information":{"unit":2.014814814814814815,"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: JVCPCT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ","drug_information":{"unit":1.511111111111111111,"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: JVCPCT LOCATION"}]},{"description":"BACITRACIN 100,000 UNITS IN 500 ML 0.9% NORMAL SALINE - ONE STEP","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000004030","type":"CDM"},{"code":"00000004030","type":"NDC"}],"standard_charges":[{"gross_charge":249.13,"discounted_cash":87.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 0.12%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00000004031","type":"CDM"},{"code":"00000004031","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MILRINONE 2 MG IN NS 30 ML - ONE STEP","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000004032","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00000004032","type":"NDC"}],"standard_charges":[{"gross_charge":93.73,"discounted_cash":32.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MILRINONE 10 MG AND HEPARIN 10,000 UNITS IN NS 1000 ML - ONE STEP","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000004033","type":"CDM"},{"code":"00000004033","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VASOPRESSIN 10 UNITS IN 100 ML NS - ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004035","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"00000004035","type":"NDC"}],"standard_charges":[{"gross_charge":247.46,"discounted_cash":86.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VASOPRESSIN 10 UNITS IN 40 ML NS - ONE STEP","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx00000004036","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"00000004036","type":"NDC"}],"standard_charges":[{"gross_charge":100.15,"discounted_cash":35.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VASOPRESSIN 10 UNITS IN 10 ML NS - ONE STEP","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000004037","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"00000004037","type":"NDC"}],"standard_charges":[{"gross_charge":100.21,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VASOPRESSIN 20 UNITS IN 250 ML NS - ONE STEP","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000004039","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"00000004039","type":"NDC"}],"standard_charges":[{"gross_charge":242.75,"discounted_cash":84.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BACITRATIN 100,000 UNITS IN 1000 ML 0.9% NORMAL SALINE - ONE STEP","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000004050","type":"CDM"},{"code":"00000004050","type":"NDC"}],"standard_charges":[{"gross_charge":248.94,"discounted_cash":87.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BACITRACIN 100,000 UNITS IN 100 ML 0.9% NORMAL SALINE - ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004051","type":"CDM"},{"code":"00000004051","type":"NDC"}],"standard_charges":[{"gross_charge":248.9,"discounted_cash":87.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN 10,000 UNITS IN 1000 ML 0.9% NORMAL SALINE - ONE STEP","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000004055","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00000004055","type":"NDC"}],"standard_charges":[{"gross_charge":134.4,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BACITRACIN 100,000 UNITS IN 3000 ML 0.9% NORMAL SALINE - ONE STEP","drug_information":{"unit":3000.0,"type":"ML"},"code_information":[{"code":"Rx00000004066","type":"CDM"},{"code":"00000004066","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EPINEPHRINE 1:1000 1 ML IN 3000 ML NS - ONE STEP","drug_information":{"unit":3000.0,"type":"ML"},"code_information":[{"code":"Rx00000004067","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"00000004067","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.25%-EPI 1:200,000 30 ML AND CLONIDINE 50 MCG (0.5 ML) AND MORPHINE SULFATE 10 MG - ONE STEP","drug_information":{"unit":30.5,"type":"ML"},"code_information":[{"code":"Rx00000004069","type":"CDM"},{"code":"00000004069","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.25% 5 ML WITH FENTANYL 2 ML - ONE STEP","drug_information":{"unit":7.0,"type":"ML"},"code_information":[{"code":"Rx00000004070","type":"CDM"},{"code":"00000004070","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.5% 1 ML WITH FENTANYL 2 ML - ONE STEP","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00000004071","type":"CDM"},{"code":"00000004071","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.25%-EPI 1:200,000 30 ML AND MORPHINE 5 MG - ONE STEP","drug_information":{"unit":30.5,"type":"ML"},"code_information":[{"code":"Rx00000004074","type":"CDM"},{"code":"00000004074","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EPIDURAL BOLUS: BUPIVACAINE 0.25% 5 ML AND FENTANYL 2 ML - ONE STEP","drug_information":{"unit":7.0,"type":"ML"},"code_information":[{"code":"Rx00000004075","type":"CDM"},{"code":"00000004075","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.5% 30 ML AND MORPHINE 10 MG - ONE STEP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004077","type":"CDM"},{"code":"00000004077","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.25%-EPI 30 ML,CLONIDINE 50 MCG,MORPHINE 4 MG - ONE STEP","drug_information":{"unit":31.5,"type":"ML"},"code_information":[{"code":"Rx00000004083","type":"CDM"},{"code":"00000004083","type":"NDC"}],"standard_charges":[{"gross_charge":150.21,"discounted_cash":52.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.25%-EPI 30 ML,CLONIDINE 50 MCG,MORPHINE 10 MG ONE STEP","drug_information":{"unit":31.5,"type":"ML"},"code_information":[{"code":"Rx00000004084","type":"CDM"},{"code":"00000004084","type":"NDC"}],"standard_charges":[{"gross_charge":150.21,"discounted_cash":52.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.25% 60 ML WITH LIDOCAINE 1%-EPI 1:100000 60 ML ONE STEP","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx00000004085","type":"CDM"},{"code":"00000004085","type":"NDC"}],"standard_charges":[{"gross_charge":189.5,"discounted_cash":66.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE 1%-EPI 1:100000 20 ML WITH KETOROLAC 30 MG - ONE STEP","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000004086","type":"CDM"},{"code":"00000004086","type":"NDC"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"1:1 LIDOCAINE 2%-EPI 1:100000, BUPIVACAINE 0.5%-EPI - ONE STEP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004087","type":"CDM"},{"code":"00000004087","type":"NDC"}],"standard_charges":[{"gross_charge":93.32,"discounted_cash":32.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE 1%-EPI 1:100000 50 ML IN NS 500 ML - ONE STEP","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000004089","type":"CDM"},{"code":"00000004089","type":"NDC"}],"standard_charges":[{"gross_charge":241.5,"discounted_cash":84.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE 1%-EPI 1:100000 50 ML IN NS 50 ML - ONE STEP","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000004090","type":"CDM"},{"code":"00000004090","type":"NDC"}],"standard_charges":[{"gross_charge":241.5,"discounted_cash":84.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE 1%-EPI 1:100000 20 ML IN NS 100 ML - ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004091","type":"CDM"},{"code":"00000004091","type":"NDC"}],"standard_charges":[{"gross_charge":241.8,"discounted_cash":84.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"1:1 LIDOCAINE 1%-EPI 1:100000 WITH BUPIVACAINE 0.25%-EPI - ONE STEP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004092","type":"CDM"},{"code":"00000004092","type":"NDC"}],"standard_charges":[{"gross_charge":93.38,"discounted_cash":32.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"1:1 LIDOCAINE 2% AND BUPIVACAINE 0.5%-EPI - ONE STEP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004093","type":"CDM"},{"code":"00000004093","type":"NDC"}],"standard_charges":[{"gross_charge":93.35,"discounted_cash":32.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.25% 30 ML AND MORPHINE 10 MG - ONE STEP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004095","type":"CDM"},{"code":"00000004095","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.75% 30 ML WITH DEXTRAN 40 30 ML - ONE STEP","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx00000004097","type":"CDM"},{"code":"00000004097","type":"NDC"}],"standard_charges":[{"gross_charge":98.23,"discounted_cash":34.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXYCYCLINE 100 MG IN 500 ML 0.9% NORMAL SALINE - ONE STEP","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000004099","type":"CDM"},{"code":"00000004099","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EPINEPHRINE 1:1000 0.3 ML AND DEPO-MEDROL 40 MG AND CEFUROXIME 750 MG IN 30 ML - ONE STEP","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000004102","type":"CDM"},{"code":"00000004102","type":"NDC"}],"standard_charges":[{"gross_charge":102.13,"discounted_cash":35.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE 0.5%-EPI 1:200000 50 ML WITH NS 1000 ML - ONE STEP","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000004104","type":"CDM"},{"code":"00000004104","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.5% 30ML, LIDOCAINE 1% 30ML, NA BICARB 4.2% 3ML ONE STEP","drug_information":{"unit":63.0,"type":"ML"},"code_information":[{"code":"Rx00000004105","type":"CDM"},{"code":"00000004105","type":"NDC"}],"standard_charges":[{"gross_charge":97.72,"discounted_cash":34.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN 10000 UNITS IN NORMAL SALINE 1000 ML - ONE STEP","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000004107","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00000004107","type":"NDC"}],"standard_charges":[{"gross_charge":103.25,"discounted_cash":36.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN 1000 UNITS IN 100 ML NS IRRIGATION - ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004108","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00000004108","type":"NDC"}],"standard_charges":[{"gross_charge":93.75,"discounted_cash":32.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN 1000 UNITS AND NORMAL SALINE 9 ML - ONE STEP","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000004110","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00000004110","type":"NDC"}],"standard_charges":[{"gross_charge":94.25,"discounted_cash":32.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN 2500 UNITS, PAPAVERINE 60 MG IN 250 ML NS - ONE STEP","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000004112","type":"CDM"},{"code":"00000004112","type":"NDC"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN 5000 UNITS IN NORMAL SALINE 250 ML - ONE STEP","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000004113","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00000004113","type":"NDC"}],"standard_charges":[{"gross_charge":94.07,"discounted_cash":32.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN 5000 UNITS IN NORMAL SALINE 5000 ML - ONE STEP","drug_information":{"unit":5000.0,"type":"ML"},"code_information":[{"code":"Rx00000004114","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00000004114","type":"NDC"}],"standard_charges":[{"gross_charge":94.29,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN 5000 UNITS AND NORMAL SALINE 5 ML - ONE STEP","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000004115","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00000004115","type":"NDC"}],"standard_charges":[{"gross_charge":94.25,"discounted_cash":32.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE 0.5%-EPI 1:200000 20 ML IN NS 1000 ML - ONE STEP","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000004116","type":"CDM"},{"code":"00000004116","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE 1%-EPI 1:100000 20 ML IN NS 1000 ML - ONE STEP","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000004117","type":"CDM"},{"code":"00000004117","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 0.8-0.16 MG/ML IV SOLN (COMPOUND)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004119","type":"CDM"},{"code":"00000004119","type":"NDC"}],"standard_charges":[{"gross_charge":99.25,"discounted_cash":34.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 0.008-0.0016 MG/ML IV SOLN (COMPOUND)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004120","type":"CDM"},{"code":"00000004120","type":"NDC"}],"standard_charges":[{"gross_charge":93.85,"discounted_cash":32.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004133","type":"CDM"},{"code":"00000004133","type":"NDC"}],"standard_charges":[{"gross_charge":93.31,"discounted_cash":32.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ROPIVACAINE HCL 0.2% ON-Q SINGLE LUMEN PUMP","drug_information":{"unit":600.0,"type":"ML"},"code_information":[{"code":"Rx00000004139","type":"CDM"},{"code":"00000004139","type":"NDC"}],"standard_charges":[{"gross_charge":1935.36,"discounted_cash":677.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VASOPRESSIN 10 UNITS & BUPIVACAINE 0.25% 30 ML - ONE STEP","drug_information":{"unit":30.5,"type":"ML"},"code_information":[{"code":"Rx00000004162","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"00000004162","type":"NDC"}],"standard_charges":[{"gross_charge":17492.65,"discounted_cash":6122.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ROPIVACAINE 0.5% 10 ML & DURAMORPH 10 MG & TORADOL 30 MG - ONE STEP","drug_information":{"unit":21.0,"type":"ML"},"code_information":[{"code":"Rx00000004163","type":"CDM"},{"code":"00000004163","type":"NDC"}],"standard_charges":[{"gross_charge":172.73,"discounted_cash":60.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004164","type":"CDM"},{"code":"00000004164","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004165","type":"CDM"},{"code":"00000004165","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004168","type":"CDM"},{"code":"00000004168","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.25% DBL LUMN ON-Q PUMP 100 ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004172","type":"CDM"},{"code":"00000004172","type":"NDC"}],"standard_charges":[{"gross_charge":98.15,"discounted_cash":34.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.5% DBL LUMN ON-Q PUMP 100 ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004173","type":"CDM"},{"code":"00000004173","type":"NDC"}],"standard_charges":[{"gross_charge":98.15,"discounted_cash":34.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.25% DBL LUMN ON-Q PUMP 270 ML","drug_information":{"unit":270.0,"type":"ML"},"code_information":[{"code":"Rx00000004174","type":"CDM"},{"code":"00000004174","type":"NDC"}],"standard_charges":[{"gross_charge":148.17,"discounted_cash":51.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.5% DBL LUMN ON-Q PUMP 270 ML","drug_information":{"unit":270.0,"type":"ML"},"code_information":[{"code":"Rx00000004175","type":"CDM"},{"code":"00000004175","type":"NDC"}],"standard_charges":[{"gross_charge":145.15,"discounted_cash":50.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ROPIVACAINE 0.2% DBL LUMN ON-Q PUMP 600 ML","drug_information":{"unit":600.0,"type":"ML"},"code_information":[{"code":"Rx00000004177","type":"CDM"},{"code":"00000004177","type":"NDC"}],"standard_charges":[{"gross_charge":1579.2,"discounted_cash":552.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.5%-EPI 1:200 24 ML,TORADOL 30 MG DURAMORPH 5 MG TOTAL 30 ML - ONE STEP","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000004179","type":"CDM"},{"code":"00000004179","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.5%-EPI 1:200 24 ML,TORADOL 30 MG DURAMORPH 4 MG TOTAL 30 ML - ONE STEP","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000004180","type":"CDM"},{"code":"00000004180","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE 1%-EPI 1:100 20 ML, 0.5% BUPIVACAINE 20 ML 1:1 TOTAL 40 ML - ONE STEP","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx00000004181","type":"CDM"},{"code":"00000004181","type":"NDC"}],"standard_charges":[{"gross_charge":97.93,"discounted_cash":34.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.25% 20 ML, LIDOCAINE 1%-EPI 1:100 20 ML,TOTAL 1:1:1 60 ML - ONE STEP","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx00000004182","type":"CDM"},{"code":"00000004182","type":"NDC"}],"standard_charges":[{"gross_charge":249.86,"discounted_cash":87.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.25% SNG LUMN ON-Q PUMP 100 ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004183","type":"CDM"},{"code":"00000004183","type":"NDC"}],"standard_charges":[{"gross_charge":98.15,"discounted_cash":34.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.5% SNG LUMN ON-Q PUMP 100 ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004184","type":"CDM"},{"code":"00000004184","type":"NDC"}],"standard_charges":[{"gross_charge":98.65,"discounted_cash":34.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DAPTOMYCIN CATHETER LOCK SYRINGE","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00000004186","type":"CDM"},{"code":"00000004186","type":"NDC"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUTT PASTE OINTMENT JV CPCT","drug_information":{"unit":90.0,"type":"GM"},"code_information":[{"code":"Rx00000004187","type":"CDM"},{"code":"00000004187","type":"NDC"}],"standard_charges":[{"gross_charge":43.6,"discounted_cash":15.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BACITRACIN 100,000 UNITS, POLYMIXIN B 1,000,000 UNITS IN 2000 ML NS IR","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000004190","type":"CDM"},{"code":"00000004190","type":"NDC"}],"standard_charges":[{"gross_charge":246.4,"discounted_cash":86.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARDIOPLEGIA SOLUTION (GHARAVI) - ONE STEP","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000004191","type":"CDM"},{"code":"00000004191","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARDIOPLEGIA SOLUTION (LOW POTASSIUM) ZADEH - ONE STEP","drug_information":{"unit":900.0,"type":"ML"},"code_information":[{"code":"Rx00000004192","type":"CDM"},{"code":"00000004192","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARDIOPLEGIA SOLUTION (HIGH POTASSIUM) ZADEH - ONE STEP","drug_information":{"unit":950.0,"type":"ML"},"code_information":[{"code":"Rx00000004193","type":"CDM"},{"code":"00000004193","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE HCL-SODIUM CHLORIDE 0.9% EPIDURAL INJ 0.125%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004195","type":"CDM"},{"code":"00000004195","type":"NDC"}],"standard_charges":[{"gross_charge":120.96,"discounted_cash":42.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ADENOSINE 1 MG IN NS 100 ML - ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004202","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"00000004202","type":"NDC"}],"standard_charges":[{"gross_charge":242.6,"discounted_cash":84.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VERAPAMIL 1 MG, HEPARIN 48 UNITS IN NS 10 ML - ONE STEP","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000004203","type":"CDM"},{"code":"00000004203","type":"NDC"}],"standard_charges":[{"gross_charge":94.34,"discounted_cash":33.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BETAMETHASONE SOD PHOSPHATE & ACETATE INJ SUSP 6 (3-3) MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004215","type":"CDM"},{"code":"J0702","type":"HCPCS"},{"code":"00000004215","type":"NDC"}],"standard_charges":[{"gross_charge":122.86,"discounted_cash":43.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL ADD-VANTAGE SIMPLE 100 MG","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004216","type":"CDM"},{"code":"00000004216","type":"NDC"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":87.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMINO ACID INFUSION 3% IN D10W","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000004218","type":"CDM"},{"code":"00000004218","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOLVAPTAN TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000004244","type":"CDM"},{"code":"00000004244","type":"NDC"}],"standard_charges":[{"gross_charge":438.97,"discounted_cash":153.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMPHOTERICIN B 10 MG IN 1000 ML STERILE WATER FOR IRRIGATION - ONE STEP","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000004287","type":"CDM"},{"code":"00000004287","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CALCIUM CHLORIDE ADDITIVE FOR BICARBONATE DIALYSIS","drug_information":{"unit":12.5,"type":"GM"},"code_information":[{"code":"Rx00000004501","type":"CDM"},{"code":"00000004501","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VASOPRESSIN 10 UNITS IN NORMAL SALINE 50 ML - ONE STEP","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000004572","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"00000004572","type":"NDC"}],"standard_charges":[{"gross_charge":100.21,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.25% DBL LUMN ON-Q PUMP 400 ML VARIABLE FLOW","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx00000004600","type":"CDM"},{"code":"00000004600","type":"NDC"}],"standard_charges":[{"gross_charge":1084.16,"discounted_cash":379.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPICILLIN SODIUM MINIBAG SIMPLE 1 GM","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000004622","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00000004622","type":"NDC"}],"standard_charges":[{"gross_charge":249.15,"discounted_cash":87.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IMIPENEM-CILASTATIN MINIBAG SIMPLE 500 MG","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004632","type":"CDM"},{"code":"J0743","type":"HCPCS"},{"code":"00000004632","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD MINIBAG SIMPLE 4.5 GM (4-0.5 GM)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004637","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00000004637","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AZITHROMYCIN ADD-A-VIAL 500 MG","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000004638","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"00000004638","type":"NDC"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":86.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL ADD-A-VIAL SIMPLE 1 GM (BASE EQUIVALENT)","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000004639","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00000004639","type":"NDC"}],"standard_charges":[{"gross_charge":244.33,"discounted_cash":85.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ACYCLOVIR SUSP 200 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004654","type":"CDM"},{"code":"00000004654","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004656","type":"CDM"},{"code":"00000004656","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETAMINE 10 MG/ML PO SOLUTION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004662","type":"CDM"},{"code":"00000004662","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CLONAZEPAM 0.1 MG/ML SUSPENSION","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000004706","type":"CDM"},{"code":"00000004706","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ISOPROTERENOL-NACL IV SOLUTION 200 MCG/50 ML-0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000004847","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00000004847","type":"NDC"}],"standard_charges":[{"gross_charge":2474.28,"discounted_cash":866.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHENOBARBITAL 10 MG/ML INJ (NICU)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004884","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"00000004884","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 0.75 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004889","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"00000004889","type":"NDC"}],"standard_charges":[{"gross_charge":93.25,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHENYLEPHRINE-NACL PREF SYR 0.5 MG/5ML-0.9% (100 MCG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004987","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"00000004987","type":"NDC"}],"standard_charges":[{"gross_charge":93.82,"discounted_cash":32.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPICILLIN SODIUM ADD-EASE SIMPLE 1 GM","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx00000004999","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00000004999","type":"NDC"}],"standard_charges":[{"gross_charge":246.02,"discounted_cash":86.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFTAZIDIME ADD-EASE SIMPLE 1 GM","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000005007","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00000005007","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE ADD-EASE SIMPLE 100 MG","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000005008","type":"CDM"},{"code":"00000005008","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PENICILLIN G POTASSIUM ADD-EASE SIMPLE 5000000 UNIT","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000005012","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00000005012","type":"NDC"}],"standard_charges":[{"gross_charge":247.6,"discounted_cash":86.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA ADD-EASE SIMPLE 3.375 GM (3-0.375 GM)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000005013","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00000005013","type":"NDC"}],"standard_charges":[{"gross_charge":247.6,"discounted_cash":86.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"INDIGOTINDISULFONATE 40 MG IN 1000 ML STERILE WATER - ONE STEP","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000005033","type":"CDM"},{"code":"00000005033","type":"NDC"}],"standard_charges":[{"gross_charge":102.25,"discounted_cash":35.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NITROGLYCERIN 200 MCG IN 100 ML NORMAL SALINE - ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000005034","type":"CDM"},{"code":"00000005034","type":"NDC"}],"standard_charges":[{"gross_charge":95.25,"discounted_cash":33.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHYLENE BLUE 1 ML IN 1000 ML STERILE WATER - ONE STEP","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000005037","type":"CDM"},{"code":"00000005037","type":"NDC"}],"standard_charges":[{"gross_charge":100.25,"discounted_cash":35.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000005105","type":"CDM"},{"code":"00000005105","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR ORAL SOLN 50 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000005140","type":"CDM"},{"code":"00000005140","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00000005308","type":"CDM"},{"code":"00000005308","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENTANYL CIT 0.4 MG/200ML-ROPIV 0.1%-NACL 0.9% EPIDURAL INJ,FENTANYL 0.2 MG/100ML-ROPIV 0.1%-NACL 0.9% EPIDURAL INJ,FENTANYL CIT 0.1 MG/50ML-ROPIV 0.1%-NACL 0.9% SOL PREF SYR,FENTANYL 0.5 MG/250ML-ROPIV 0.1%-NACL 0.9% EPIDURAL INJ","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000005532","type":"CDM"},{"code":"00000005532","type":"NDC"}],"standard_charges":[{"gross_charge":618.2,"discounted_cash":216.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.0625% AND FENTANYL 2 MCG/ML EPIDURAL,FENTANYL 0.5 MG/250ML-BUPIV 0.0625%-NACL 0.9% PF EPIDUR INJ,FENTANYL 0.2 MG/100ML-BUPIV 0.0625%-NACL 0.9% EPIDURAL INJ","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000005590","type":"CDM"},{"code":"00000005590","type":"NDC"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SUGAMMADEX SODIUM IV 200 MG/2ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000005830","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00000005830","type":"NDC"}],"standard_charges":[{"gross_charge":541.95,"discounted_cash":189.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000006230","type":"CDM"},{"code":"00000006230","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AZITHROMYCIN ADD-A-VIAL 500 MG","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000006391","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"00000006391","type":"NDC"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":86.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE INJ 1.5% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00000006741","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00000006741","type":"NDC"}],"standard_charges":[{"gross_charge":94.18,"discounted_cash":32.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FENTANYL 10 MCG/ML PCA SYRINGE,FENTANYL CITRATE-NACL SOLN PREF SYR 550 MCG/55ML-0.9%,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 100 MCG/10ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 500 MCG/50ML,FENTANYL CITRATE-NACL SOLN PREF SYR 100 MCG/10ML-0.9%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000086810","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00000086810","type":"NDC"}],"standard_charges":[{"gross_charge":156.82,"discounted_cash":54.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OLANZAPINE-FLUOXETINE HCL CAP 6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002323330","type":"CDM"},{"code":"00002323330","type":"NDC"}],"standard_charges":[{"gross_charge":18.81,"discounted_cash":6.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OLANZAPINE-FLUOXETINE HCL CAP 12-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002323430","type":"CDM"},{"code":"00002323430","type":"NDC"}],"standard_charges":[{"gross_charge":28.3,"discounted_cash":9.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"RALOXIFENE HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002416502","type":"CDM"},{"code":"00002416502","type":"NDC"}],"standard_charges":[{"gross_charge":9.24,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PRASUGREL HCL TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002512301","type":"CDM"},{"code":"00002512301","type":"NDC"}],"standard_charges":[{"gross_charge":21.27,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":10.0,"type":"ML"},"code_information":[{"code":"Rx00002751001","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002751001","type":"NDC"}],"standard_charges":[{"gross_charge":431.22,"discounted_cash":150.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":10.0,"type":"ML"},"code_information":[{"code":"Rx00002751001","type":"CDM"},{"code":"J1817","type":"HCPCS"},{"code":"00002751001","type":"NDC"}],"standard_charges":[{"gross_charge":431.22,"discounted_cash":150.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"INSULIN LISPRO INJ SOLN 100 UNIT/ML","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: JVCPCT LOCATION"}]},{"description":"INSULIN LISPRO INJ SOLN 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002751017","type":"CDM"},{"code":"J1817","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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OLANZAPINE FOR IM INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002759701","type":"CDM"},{"code":"J2359","type":"HCPCS"},{"code":"00002759701","type":"NDC"}],"standard_charges":[{"gross_charge":516.09,"discounted_cash":180.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PEMETREXED DISODIUM FOR IV SOLN 100 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002764001","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"00002764001","type":"NDC"}],"standard_charges":[{"gross_charge":7739.17,"discounted_cash":2708.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RAMUCIRUMAB IV SOLN 100 MG/10ML (FOR INFUSION)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00002766901","type":"CDM"},{"code":"J9308","type":"HCPCS"},{"code":"00002766901","type":"NDC"}],"standard_charges":[{"gross_charge":15483.53,"discounted_cash":5419.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RAMUCIRUMAB IV SOLN 500 MG/50ML (FOR INFUSION)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00002767801","type":"CDM"},{"code":"J9308","type":"HCPCS"},{"code":"00002767801","type":"NDC"}],"standard_charges":[{"gross_charge":37332.0,"discounted_cash":13066.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (1 UNIT DIAL)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002879901","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002879901","type":"NDC"}],"standard_charges":[{"gross_charge":201.38,"discounted_cash":70.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (1 UNIT DIAL)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002879959","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002879959","type":"NDC"}],"standard_charges":[{"gross_charge":210.89,"discounted_cash":73.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00003029305","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"00003029305","type":"NDC"}],"standard_charges":[{"gross_charge":97.54,"discounted_cash":34.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"APIXABAN TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003089321","type":"CDM"},{"code":"00003089321","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"APIXABAN TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003089421","type":"CDM"},{"code":"00003089421","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ELOTUZUMAB FOR IV SOLN 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003229111","type":"CDM"},{"code":"J9176","type":"HCPCS"},{"code":"00003229111","type":"NDC"}],"standard_charges":[{"gross_charge":23891.11,"discounted_cash":8361.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IPILIMUMAB SOLN FOR IV INFUSION 50 MG/10ML (5 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00003232711","type":"CDM"},{"code":"J9228","type":"HCPCS"},{"code":"00003232711","type":"NDC"}],"standard_charges":[{"gross_charge":45047.35,"discounted_cash":15766.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NIVOLUMAB IV SOLN 40 MG/4ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00003377211","type":"CDM"},{"code":"J9299","type":"HCPCS"},{"code":"00003377211","type":"NDC"}],"standard_charges":[{"gross_charge":13670.13,"discounted_cash":4784.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NIVOLUMAB IV SOLN 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00003377412","type":"CDM"},{"code":"J9299","type":"HCPCS"},{"code":"00003377412","type":"NDC"}],"standard_charges":[{"gross_charge":34021.06,"discounted_cash":11907.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SAXAGLIPTIN HCL TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003421411","type":"CDM"},{"code":"00003421411","type":"NDC"}],"standard_charges":[{"gross_charge":10.88,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SAXAGLIPTIN HCL TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003421511","type":"CDM"},{"code":"00003421511","type":"NDC"}],"standard_charges":[{"gross_charge":12.45,"discounted_cash":4.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ELOTUZUMAB FOR IV SOLN 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003452211","type":"CDM"},{"code":"J9176","type":"HCPCS"},{"code":"00003452211","type":"NDC"}],"standard_charges":[{"gross_charge":31820.36,"discounted_cash":11137.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV)","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx00004082009","type":"CDM"},{"code":"00004082009","type":"NDC"}],"standard_charges":[{"gross_charge":30.43,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PNEUMOCOCCAL 13-VALENT CONJUGATE VACCINE INJ","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00005197101","type":"CDM"},{"code":"90670","type":"HCPCS"},{"code":"00005197101","type":"NDC"}],"standard_charges":[{"gross_charge":1335.55,"discounted_cash":467.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"RIZATRIPTAN BENZOATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006026618","type":"CDM"},{"code":"00006026618","type":"NDC"}],"standard_charges":[{"gross_charge":48.48,"discounted_cash":16.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PEMBROLIZUMAB IV SOLN 100 MG/4ML (25 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00006302602","type":"CDM"},{"code":"J9271","type":"HCPCS"},{"code":"00006302602","type":"NDC"}],"standard_charges":[{"gross_charge":29928.0,"discounted_cash":10474.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FOSAPREPITANT DIMEGLUMINE FOR IV INFUSION 150 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006306100","type":"CDM"},{"code":"J1453","type":"HCPCS"},{"code":"00006306100","type":"NDC"}],"standard_charges":[{"gross_charge":3435.93,"discounted_cash":1202.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DORZOLAMIDE HCL OPHTH SOLN 2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00006351936","type":"CDM"},{"code":"00006351936","type":"NDC"}],"standard_charges":[{"gross_charge":105.04,"discounted_cash":36.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RIZATRIPTAN BENZOATE ORAL DISINTEGRATING TAB 10 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006380101","type":"CDM"},{"code":"00006380101","type":"NDC"}],"standard_charges":[{"gross_charge":50.84,"discounted_cash":17.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006391868","type":"CDM"},{"code":"00006391868","type":"NDC"}],"standard_charges":[{"gross_charge":1.91,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ANTIVENIN LATRODECTUS MACTANS INJ KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006408400","type":"CDM"},{"code":"J3590","type":"HCPCS"},{"code":"00006408400","type":"NDC"}],"standard_charges":[{"gross_charge":310.35,"discounted_cash":108.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VARICELLA VIRUS VAC LIVE FOR INJ 1350 PFU/0.5ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006482700","type":"CDM"},{"code":"90716","type":"HCPCS"},{"code":"00006482700","type":"NDC"}],"standard_charges":[{"gross_charge":1516.34,"discounted_cash":530.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PNEUMOCOCCAL VACCINE POLYVALENT SOLN PREF SYR 25 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00006483701","type":"CDM"},{"code":"90732","type":"HCPCS"},{"code":"00006483701","type":"NDC"}],"standard_charges":[{"gross_charge":1255.55,"discounted_cash":439.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PNEUMOCOCCAL VACCINE POLYVALENT SOLN PREF SYR 25 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00006483703","type":"CDM"},{"code":"90732","type":"HCPCS"},{"code":"00006483703","type":"NDC"}],"standard_charges":[{"gross_charge":1130.41,"discounted_cash":395.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HAEMOPHILUS B POLYSACCHARIDE CONJ VAC IM SUSP 7.5 MCG/0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00006489700","type":"CDM"},{"code":"90647","type":"HCPCS"},{"code":"00006489700","type":"NDC"}],"standard_charges":[{"gross_charge":321.89,"discounted_cash":112.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 10 MG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx00007323601","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"00007323601","type":"NDC"}],"standard_charges":[{"gross_charge":599.42,"discounted_cash":209.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB ER 24HR 8 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00007488813","type":"CDM"},{"code":"00007488813","type":"NDC"}],"standard_charges":[{"gross_charge":20.47,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008060601","type":"CDM"},{"code":"00008060601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008060701","type":"CDM"},{"code":"00008060701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TEMSIROLIMUS SOLN FOR IV INFUSION 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00008117901","type":"CDM"},{"code":"J9330","type":"HCPCS"},{"code":"00008117901","type":"NDC"}],"standard_charges":[{"gross_charge":18993.77,"discounted_cash":6647.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009000302","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009000302","type":"NDC"}],"standard_charges":[{"gross_charge":476.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BACITRACIN INTRAMUSCULAR FOR SOLN 50000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009023301","type":"CDM"},{"code":"00009023301","type":"NDC"}],"standard_charges":[{"gross_charge":99.1,"discounted_cash":34.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GELATIN ABSORBABLE SPONGE SIZE 50","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009032301","type":"CDM"},{"code":"00009032301","type":"NDC"}],"standard_charges":[{"gross_charge":43.75,"discounted_cash":15.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TESTOSTERONE CYPIONATE IM INJ IN OIL 200 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00009041701","type":"CDM"},{"code":"J1071","type":"HCPCS"},{"code":"00009041701","type":"NDC"}],"standard_charges":[{"gross_charge":158.22,"discounted_cash":55.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ARGININE HCL INJ 10%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00009043624","type":"CDM"},{"code":"00009043624","type":"NDC"}],"standard_charges":[{"gross_charge":295.68,"discounted_cash":103.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00009074630","type":"CDM"},{"code":"J1050","type":"HCPCS"},{"code":"00009074630","type":"NDC"}],"standard_charges":[{"gross_charge":540.51,"discounted_cash":189.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 600 MG/4ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00009077526","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00009077526","type":"NDC"}],"standard_charges":[{"gross_charge":94.59,"discounted_cash":33.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 2000 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009079601","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009079601","type":"NDC"}],"standard_charges":[{"gross_charge":850.97,"discounted_cash":297.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00009337501","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00009337501","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00009338201","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00009338201","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 80 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00009347501","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"00009347501","type":"NDC"}],"standard_charges":[{"gross_charge":99.32,"discounted_cash":34.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"IBUTILIDE FUMARATE INJ 1 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00009379422","type":"CDM"},{"code":"J1742","type":"HCPCS"},{"code":"00009379422","type":"NDC"}],"standard_charges":[{"gross_charge":904.28,"discounted_cash":316.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LINEZOLID FOR SUSP 100 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00009513601","type":"CDM"},{"code":"00009513601","type":"NDC"}],"standard_charges":[{"gross_charge":187.69,"discounted_cash":65.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","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: JVCPCT LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009519001","type":"CDM"},{"code":"00009519001","type":"NDC"}],"standard_charges":[{"gross_charge":16.94,"discounted_cash":5.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009519004","type":"CDM"},{"code":"00009519004","type":"NDC"}],"standard_charges":[{"gross_charge":17.17,"discounted_cash":6.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009519101","type":"CDM"},{"code":"00009519101","type":"NDC"}],"standard_charges":[{"gross_charge":18.9,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009519104","type":"CDM"},{"code":"00009519104","type":"NDC"}],"standard_charges":[{"gross_charge":17.16,"discounted_cash":6.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LYMPHOCYTE IMMUNE GLOBULIN ANTI-THYMOCYTE G INJ 50 MG/ML(EQ)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00009722402","type":"CDM"},{"code":"J7504","type":"HCPCS"},{"code":"00009722402","type":"NDC"}],"standard_charges":[{"gross_charge":51975.5,"discounted_cash":18191.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IRINOTECAN HCL INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00009752903","type":"CDM"},{"code":"J9206","type":"HCPCS"},{"code":"00009752903","type":"NDC"}],"standard_charges":[{"gross_charge":319.87,"discounted_cash":111.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESTRAMUSTINE PHOSPHATE SODIUM CAP 140 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00013013202","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00013013202","type":"NDC"}],"standard_charges":[{"gross_charge":23.05,"discounted_cash":8.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"RIFABUTIN CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00013530117","type":"CDM"},{"code":"00013530117","type":"NDC"}],"standard_charges":[{"gross_charge":11.22,"discounted_cash":3.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARMUSTINE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00015301260","type":"CDM"},{"code":"J9050","type":"HCPCS"},{"code":"00015301260","type":"NDC"}],"standard_charges":[{"gross_charge":1796.48,"discounted_cash":628.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BIMATOPROST OPHTH SOLN 0.01%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00023320503","type":"CDM"},{"code":"00023320503","type":"NDC"}],"standard_charges":[{"gross_charge":362.86,"discounted_cash":127.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYCLOSPORINE (OPHTH) EMULSION 0.05%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00023916330","type":"CDM"},{"code":"00023916330","type":"NDC"}],"standard_charges":[{"gross_charge":14.79,"discounted_cash":5.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BRIMONIDINE TARTRATE-TIMOLOL MALEATE OPHTH SOLN 0.2-0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00023921105","type":"CDM"},{"code":"00023921105","type":"NDC"}],"standard_charges":[{"gross_charge":280.62,"discounted_cash":98.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PRIMAQUINE PHOSPHATE TAB 26.3 MG (15 MG BASE)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00024159601","type":"CDM"},{"code":"00024159601","type":"NDC"}],"standard_charges":[{"gross_charge":2.81,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SARILUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 200 MG/1.14ML","drug_information":{"unit":1.14,"type":"ML"},"code_information":[{"code":"Rx00024591001","type":"CDM"},{"code":"J3590","type":"HCPCS"},{"code":"00024591001","type":"NDC"}],"standard_charges":[{"gross_charge":23638.38,"discounted_cash":8273.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00025152034","type":"CDM"},{"code":"00025152034","type":"NDC"}],"standard_charges":[{"gross_charge":12.34,"discounted_cash":4.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CELECOXIB CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00025152534","type":"CDM"},{"code":"00025152534","type":"NDC"}],"standard_charges":[{"gross_charge":22.57,"discounted_cash":7.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DISOPYRAMIDE PHOSPHATE CAP ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00025274231","type":"CDM"},{"code":"00025274231","type":"NDC"}],"standard_charges":[{"gross_charge":7.01,"discounted_cash":2.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AZELASTINE HCL NASAL SPRAY 0.15% (205.5 MCG/SPRAY)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00037024330","type":"CDM"},{"code":"00037024330","type":"NDC"}],"standard_charges":[{"gross_charge":113.89,"discounted_cash":39.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FELBAMATE SUSP 600 MG/5ML","drug_information":{"unit":237.0,"type":"ML"},"code_information":[{"code":"Rx00037044267","type":"CDM"},{"code":"00037044267","type":"NDC"}],"standard_charges":[{"gross_charge":2454.72,"discounted_cash":859.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFOTAXIME SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00039001801","type":"CDM"},{"code":"J0698","type":"HCPCS"},{"code":"00039001801","type":"NDC"}],"standard_charges":[{"gross_charge":94.39,"discounted_cash":33.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFOTAXIME SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00039001901","type":"CDM"},{"code":"J0698","type":"HCPCS"},{"code":"00039001901","type":"NDC"}],"standard_charges":[{"gross_charge":96.51,"discounted_cash":33.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ESTROGENS, CONJUGATED TAB 0.9 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00046110381","type":"CDM"},{"code":"00046110381","type":"NDC"}],"standard_charges":[{"gross_charge":9.72,"discounted_cash":3.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESTROGENS, CONJUGATED TAB 1.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00046110481","type":"CDM"},{"code":"00046110481","type":"NDC"}],"standard_charges":[{"gross_charge":9.72,"discounted_cash":3.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049001383","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00049001383","type":"NDC"}],"standard_charges":[{"gross_charge":100.19,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049052022","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00049052022","type":"NDC"}],"standard_charges":[{"gross_charge":97.92,"discounted_cash":34.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049052084","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00049052084","type":"NDC"}],"standard_charges":[{"gross_charge":97.31,"discounted_cash":34.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ZIPRASIDONE MESYLATE FOR INJ 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049392020","type":"CDM"},{"code":"J3486","type":"HCPCS"},{"code":"00049392020","type":"NDC"}],"standard_charges":[{"gross_charge":661.78,"discounted_cash":231.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ZIPRASIDONE MESYLATE FOR INJ 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049392083","type":"CDM"},{"code":"J3486","type":"HCPCS"},{"code":"00049392083","type":"NDC"}],"standard_charges":[{"gross_charge":661.78,"discounted_cash":231.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TESTOSTERONE TD GEL 25 MG/2.5GM (1%)","drug_information":{"unit":2.5,"type":"GM"},"code_information":[{"code":"Rx00051842501","type":"CDM"},{"code":"00051842501","type":"NDC"}],"standard_charges":[{"gross_charge":28.78,"discounted_cash":10.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TESTOSTERONE TD GEL 25 MG/2.5GM (1%)","drug_information":{"unit":2.5,"type":"GM"},"code_information":[{"code":"Rx00051842530","type":"CDM"},{"code":"00051842530","type":"NDC"}],"standard_charges":[{"gross_charge":28.78,"discounted_cash":10.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054000713","type":"CDM"},{"code":"00054000713","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001121","type":"CDM"},{"code":"00054001121","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001125","type":"CDM"},{"code":"00054001125","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001825","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054001825","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"IPRATROPIUM BROMIDE NASAL SOLN 0.03% (21 MCG/SPRAY)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00054004544","type":"CDM"},{"code":"00054004544","type":"NDC"}],"standard_charges":[{"gross_charge":50.22,"discounted_cash":17.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IPRATROPIUM BROMIDE NASAL SOLN 0.06% (42 MCG/SPRAY)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00054004641","type":"CDM"},{"code":"00054004641","type":"NDC"}],"standard_charges":[{"gross_charge":50.22,"discounted_cash":17.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CITALOPRAM HYDROBROMIDE ORAL SOLN 10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00054006258","type":"CDM"},{"code":"00054006258","type":"NDC"}],"standard_charges":[{"gross_charge":2.37,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ZALEPLON CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054008425","type":"CDM"},{"code":"00054008425","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"RAMIPRIL CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054010720","type":"CDM"},{"code":"00054010720","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054011725","type":"CDM"},{"code":"00054011725","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ACARBOSE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054014025","type":"CDM"},{"code":"00054014025","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054016325","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"00054016325","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OXCARBAZEPINE SUSP 300 MG/5ML (60 MG/ML)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00054019959","type":"CDM"},{"code":"00054019959","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054022020","type":"CDM"},{"code":"00054022020","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054022025","type":"CDM"},{"code":"00054022025","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CODEINE SULFATE TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054024424","type":"CDM"},{"code":"00054024424","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054038225","type":"CDM"},{"code":"J8530","type":"HCPCS"},{"code":"00054038225","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":3.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RITONAVIR TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054040713","type":"CDM"},{"code":"00054040713","type":"NDC"}],"standard_charges":[{"gross_charge":7.33,"discounted_cash":2.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DEXAMETHASONE CONC 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00054317644","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054317644","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METHADONE HCL SOLN 10 MG/5ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00054355663","type":"CDM"},{"code":"00054355663","type":"NDC"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CLOTRIMAZOLE TROCHE 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054414623","type":"CDM"},{"code":"00054414623","type":"NDC"}],"standard_charges":[{"gross_charge":2.38,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEUCOVORIN CALCIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054449613","type":"CDM"},{"code":"00054449613","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AZATHIOPRINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054808425","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"00054808425","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054829725","type":"CDM"},{"code":"00054829725","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054855025","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"00054855025","type":"NDC"}],"standard_charges":[{"gross_charge":4.19,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056016801","type":"CDM"},{"code":"00056016801","type":"NDC"}],"standard_charges":[{"gross_charge":1.86,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056016901","type":"CDM"},{"code":"00056016901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056017001","type":"CDM"},{"code":"00056017001","type":"NDC"}],"standard_charges":[{"gross_charge":2.98,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056017601","type":"CDM"},{"code":"00056017601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056018801","type":"CDM"},{"code":"00056018801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TERCONAZOLE VAGINAL CREAM 0.4%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx00062535001","type":"CDM"},{"code":"00062535001","type":"NDC"}],"standard_charges":[{"gross_charge":61.76,"discounted_cash":21.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TERCONAZOLE VAGINAL CREAM 0.8%","drug_information":{"unit":20.0,"type":"GM"},"code_information":[{"code":"Rx00062535601","type":"CDM"},{"code":"00062535601","type":"NDC"}],"standard_charges":[{"gross_charge":61.77,"discounted_cash":21.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"COLLAGENASE OINT 250 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00064501030","type":"CDM"},{"code":"00064501030","type":"NDC"}],"standard_charges":[{"gross_charge":268.15,"discounted_cash":93.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NEPAFENAC OPHTH SUSP 0.1%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00065000203","type":"CDM"},{"code":"00065000203","type":"NDC"}],"standard_charges":[{"gross_charge":395.26,"discounted_cash":138.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUORESCEIN SODIUM IV SOLN 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00065009265","type":"CDM"},{"code":"A9612","type":"HCPCS"},{"code":"00065009265","type":"NDC"}],"standard_charges":[{"gross_charge":589.45,"discounted_cash":206.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BETAXOLOL HCL OPHTH SUSP 0.25%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00065024610","type":"CDM"},{"code":"00065024610","type":"NDC"}],"standard_charges":[{"gross_charge":451.87,"discounted_cash":158.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BETAXOLOL HCL OPHTH SUSP 0.25%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00065024615","type":"CDM"},{"code":"00065024615","type":"NDC"}],"standard_charges":[{"gross_charge":677.74,"discounted_cash":237.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TRAVOPROST OPHTH SOLN 0.004% (BENZALKONIUM FREE) (BAK FREE)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00065026025","type":"CDM"},{"code":"00065026025","type":"NDC"}],"standard_charges":[{"gross_charge":269.7,"discounted_cash":94.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BRINZOLAMIDE OPHTH SUSP 1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00065027510","type":"CDM"},{"code":"00065027510","type":"NDC"}],"standard_charges":[{"gross_charge":473.28,"discounted_cash":165.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00065030355","type":"CDM"},{"code":"00065030355","type":"NDC"}],"standard_charges":[{"gross_charge":66.99,"discounted_cash":23.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OLOPATADINE HCL NASAL SOLN 0.6%","drug_information":{"unit":30.5,"type":"GM"},"code_information":[{"code":"Rx00065033230","type":"CDM"},{"code":"00065033230","type":"NDC"}],"standard_charges":[{"gross_charge":401.22,"discounted_cash":140.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00065039602","type":"CDM"},{"code":"00065039602","type":"NDC"}],"standard_charges":[{"gross_charge":46.48,"discounted_cash":16.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 2%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00065039702","type":"CDM"},{"code":"00065039702","type":"NDC"}],"standard_charges":[{"gross_charge":48.39,"discounted_cash":16.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00065039705","type":"CDM"},{"code":"00065039705","type":"NDC"}],"standard_charges":[{"gross_charge":100.6,"discounted_cash":35.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE OPHTH SUSP 0.3-0.1%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00065064725","type":"CDM"},{"code":"00065064725","type":"NDC"}],"standard_charges":[{"gross_charge":114.64,"discounted_cash":40.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CIPROFLOXACIN HCL OPHTH OINT 0.3%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00065065435","type":"CDM"},{"code":"00065065435","type":"NDC"}],"standard_charges":[{"gross_charge":296.88,"discounted_cash":103.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MOXIFLOXACIN HCL OPHTH SOLN 0.5% (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00065401303","type":"CDM"},{"code":"00065401303","type":"NDC"}],"standard_charges":[{"gross_charge":240.88,"discounted_cash":84.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00067434509","type":"CDM"},{"code":"00067434509","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":8.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00069005904","type":"CDM"},{"code":"J1643","type":"HCPCS"},{"code":"00069005904","type":"NDC"}],"standard_charges":[{"gross_charge":93.43,"discounted_cash":32.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOBRAMYCIN SULFATE INJ 80 MG/2ML (40 MG/ML) (BASE EQUIV)","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":95.14,"discounted_cash":33.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VINORELBINE TARTRATE INJ 10 MG/ML (BASE EQUIV)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069009901","type":"CDM"},{"code":"J9390","type":"HCPCS"},{"code":"00069009901","type":"NDC"}],"standard_charges":[{"gross_charge":288.02,"discounted_cash":100.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VINORELBINE TARTRATE INJ 50 MG/5ML (10 MG/ML) (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00069010303","type":"CDM"},{"code":"J9390","type":"HCPCS"},{"code":"00069010303","type":"NDC"}],"standard_charges":[{"gross_charge":2252.26,"discounted_cash":788.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DALTEPARIN SODIUM SOLN PREFILLED SYR 5000 UNIT/0.2ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00069019602","type":"CDM"},{"code":"J1645","type":"HCPCS"},{"code":"00069019602","type":"NDC"}],"standard_charges":[{"gross_charge":153.14,"discounted_cash":53.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DALTEPARIN SODIUM SOLN PREFILLED SYR 7500 UNIT/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx00069020602","type":"CDM"},{"code":"J1645","type":"HCPCS"},{"code":"00069020602","type":"NDC"}],"standard_charges":[{"gross_charge":229.88,"discounted_cash":80.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00069027702","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00069027702","type":"NDC"}],"standard_charges":[{"gross_charge":289.34,"discounted_cash":101.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00069035820","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00069035820","type":"NDC"}],"standard_charges":[{"gross_charge":286.83,"discounted_cash":100.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXYCYCLINE MONOHYDRATE FOR SUSP 25 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00069097065","type":"CDM"},{"code":"00069097065","type":"NDC"}],"standard_charges":[{"gross_charge":9.58,"discounted_cash":3.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 40000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130904","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130904","type":"NDC"}],"standard_charges":[{"gross_charge":3860.24,"discounted_cash":1351.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 20000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069131110","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069131110","type":"NDC"}],"standard_charges":[{"gross_charge":1930.11,"discounted_cash":675.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 10000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069131810","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069131810","type":"NDC"}],"standard_charges":[{"gross_charge":965.05,"discounted_cash":337.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00069303020","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00069303020","type":"NDC"}],"standard_charges":[{"gross_charge":287.79,"discounted_cash":100.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SILDENAFIL CITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069419068","type":"CDM"},{"code":"00069419068","type":"NDC"}],"standard_charges":[{"gross_charge":85.07,"discounted_cash":29.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SILDENAFIL CITRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069420030","type":"CDM"},{"code":"00069420030","type":"NDC"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":42.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOFETILIDE CAP 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069580043","type":"CDM"},{"code":"00069580043","type":"NDC"}],"standard_charges":[{"gross_charge":15.66,"discounted_cash":5.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOFETILIDE CAP 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069580061","type":"CDM"},{"code":"00069580061","type":"NDC"}],"standard_charges":[{"gross_charge":4.67,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00069600121","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"00069600121","type":"NDC"}],"standard_charges":[{"gross_charge":249.11,"discounted_cash":87.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00069600125","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"00069600125","type":"NDC"}],"standard_charges":[{"gross_charge":415.18,"discounted_cash":145.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071036940","type":"CDM"},{"code":"00071036940","type":"NDC"}],"standard_charges":[{"gross_charge":2.62,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071041813","type":"CDM"},{"code":"00071041813","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PREGABALIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071101268","type":"CDM"},{"code":"00071101268","type":"NDC"}],"standard_charges":[{"gross_charge":13.91,"discounted_cash":4.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071374066","type":"CDM"},{"code":"00071374066","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PARICALCITOL IV SOLN 5 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00074165801","type":"CDM"},{"code":"J2501","type":"HCPCS"},{"code":"00074165801","type":"NDC"}],"standard_charges":[{"gross_charge":102.41,"discounted_cash":35.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEUPROLIDE ACETATE FOR INJ PEDIATRIC KIT 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074210803","type":"CDM"},{"code":"J1950","type":"HCPCS"},{"code":"00074210803","type":"NDC"}],"standard_charges":[{"gross_charge":22250.92,"discounted_cash":7787.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NIACIN TAB ER 500 MG (ANTIHYPERLIPIDEMIC)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074307490","type":"CDM"},{"code":"00074307490","type":"NDC"}],"standard_charges":[{"gross_charge":7.21,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NIACIN TAB ER 750 MG (ANTIHYPERLIPIDEMIC)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074307990","type":"CDM"},{"code":"00074307990","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":3.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEUPROLIDE ACETATE (3 MONTH) FOR INJ KIT 11.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074366303","type":"CDM"},{"code":"J1950","type":"HCPCS"},{"code":"00074366303","type":"NDC"}],"standard_charges":[{"gross_charge":39395.5,"discounted_cash":13788.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 137 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074372790","type":"CDM"},{"code":"00074372790","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074455211","type":"CDM"},{"code":"00074455211","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 125 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074706811","type":"CDM"},{"code":"00074706811","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 150 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074706911","type":"CDM"},{"code":"00074706911","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 175 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074707090","type":"CDM"},{"code":"00074707090","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 112 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074929690","type":"CDM"},{"code":"00074929690","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.8666666666666666667,"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: JVCPCT LOCATION"}]},{"description":"DOCETAXEL FOR INJ CONC 80 MG/4ML (20 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00075800404","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"00075800404","type":"NDC"}],"standard_charges":[{"gross_charge":22197.09,"discounted_cash":7768.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYCLOSPORINE IV SOLN 50 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00078010961","type":"CDM"},{"code":"J7516","type":"HCPCS"},{"code":"00078010961","type":"NDC"}],"standard_charges":[{"gross_charge":624.84,"discounted_cash":218.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 50 MCG/ML (0.05 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00078018001","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"00078018001","type":"NDC"}],"standard_charges":[{"gross_charge":144.96,"discounted_cash":50.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VALSARTAN TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078035834","type":"CDM"},{"code":"00078035834","type":"NDC"}],"standard_charges":[{"gross_charge":13.03,"discounted_cash":4.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VALSARTAN TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078035934","type":"CDM"},{"code":"00078035934","type":"NDC"}],"standard_charges":[{"gross_charge":14.01,"discounted_cash":4.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"IMATINIB MESYLATE TAB 100 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078040134","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00078040134","type":"NDC"}],"standard_charges":[{"gross_charge":128.78,"discounted_cash":45.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ALISKIREN FUMARATE TAB 150 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078048515","type":"CDM"},{"code":"00078048515","type":"NDC"}],"standard_charges":[{"gross_charge":7.7,"discounted_cash":2.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALISKIREN FUMARATE TAB 150 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078048561","type":"CDM"},{"code":"00078048561","type":"NDC"}],"standard_charges":[{"gross_charge":3.87,"discounted_cash":1.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RIVASTIGMINE TD PATCH 24HR 4.6 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078050161","type":"CDM"},{"code":"00078050161","type":"NDC"}],"standard_charges":[{"gross_charge":31.79,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RIVASTIGMINE TD PATCH 24HR 9.5 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078050261","type":"CDM"},{"code":"00078050261","type":"NDC"}],"standard_charges":[{"gross_charge":31.79,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARBAMAZEPINE TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078051005","type":"CDM"},{"code":"00078051005","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE OPHTH OINT 0.3-0.1%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00078087601","type":"CDM"},{"code":"00078087601","type":"NDC"}],"standard_charges":[{"gross_charge":409.97,"discounted_cash":143.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BETAMETHASONE SOD PHOSPHATE & ACETATE INJ SUSP 6 (3-3) MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00085056605","type":"CDM"},{"code":"J0702","type":"HCPCS"},{"code":"00085056605","type":"NDC"}],"standard_charges":[{"gross_charge":99.83,"discounted_cash":34.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 75 MG/100ML (0.75 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00085113601","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"00085113601","type":"NDC"}],"standard_charges":[{"gross_charge":5631.36,"discounted_cash":1970.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 75 MG/100ML (0.75 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00085113602","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"00085113602","type":"NDC"}],"standard_charges":[{"gross_charge":5631.36,"discounted_cash":1970.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 20 MG/10ML (2 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00085117701","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"00085117701","type":"NDC"}],"standard_charges":[{"gross_charge":1799.39,"discounted_cash":629.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POSACONAZOLE SUSP 40 MG/ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00085132801","type":"CDM"},{"code":"00085132801","type":"NDC"}],"standard_charges":[{"gross_charge":47.16,"discounted_cash":16.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MOMETASONE FUROATE-FORMOTEROL FUMARATE AEROSOL 100-5 MCG/ACT","drug_information":{"unit":8.8,"type":"GM"},"code_information":[{"code":"Rx00085720607","type":"CDM"},{"code":"00085720607","type":"NDC"}],"standard_charges":[{"gross_charge":292.96,"discounted_cash":102.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"INSULIN GLARGINE SOLN PEN-INJECTOR 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00088221905","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00088221905","type":"NDC"}],"standard_charges":[{"gross_charge":203.51,"discounted_cash":71.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"INSULIN GLARGINE INJ 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00088222033","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00088222033","type":"NDC"}],"standard_charges":[{"gross_charge":498.72,"discounted_cash":174.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE TAB 300-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093015001","type":"CDM"},{"code":"00093015001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BICALUTAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093022056","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00093022056","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUOCINONIDE EMULSIFIED BASE CREAM 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00093026315","type":"CDM"},{"code":"00093026315","type":"NDC"}],"standard_charges":[{"gross_charge":25.11,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUOCINONIDE OINT 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00093026415","type":"CDM"},{"code":"00093026415","type":"NDC"}],"standard_charges":[{"gross_charge":77.85,"discounted_cash":27.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093032101","type":"CDM"},{"code":"00093032101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GEMFIBROZIL TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093067006","type":"CDM"},{"code":"00093067006","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ATENOLOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093075301","type":"CDM"},{"code":"00093075301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093081901","type":"CDM"},{"code":"00093081901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DICLOFENAC POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093094801","type":"CDM"},{"code":"00093094801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NAPROXEN TAB EC 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093100601","type":"CDM"},{"code":"00093100601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AZITHROMYCIN FOR SUSP 200 MG/5ML","drug_information":{"unit":6.25,"type":"ML"},"code_information":[{"code":"Rx00093202631","type":"CDM"},{"code":"00093202631","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":2.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AZITHROMYCIN FOR SUSP 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093202723","type":"CDM"},{"code":"00093202723","type":"NDC"}],"standard_charges":[{"gross_charge":12.16,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093205056","type":"CDM"},{"code":"00093205056","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOLTERODINE TARTRATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093205506","type":"CDM"},{"code":"00093205506","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENOFIBRATE TAB 145 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093206098","type":"CDM"},{"code":"00093206098","type":"NDC"}],"standard_charges":[{"gross_charge":6.32,"discounted_cash":2.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"RASAGILINE MESYLATE TAB 0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093306056","type":"CDM"},{"code":"00093306056","type":"NDC"}],"standard_charges":[{"gross_charge":9.58,"discounted_cash":3.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093310919","type":"CDM"},{"code":"00093310919","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DISOPYRAMIDE PHOSPHATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093312701","type":"CDM"},{"code":"00093312701","type":"NDC"}],"standard_charges":[{"gross_charge":2.74,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093314501","type":"CDM"},{"code":"00093314501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093314701","type":"CDM"},{"code":"00093314701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":8.5,"type":"GM"},"code_information":[{"code":"Rx00093317431","type":"CDM"},{"code":"00093317431","type":"NDC"}],"standard_charges":[{"gross_charge":50.18,"discounted_cash":17.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETOPROFEN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093319301","type":"CDM"},{"code":"00093319301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PENICILLIN V POTASSIUM FOR SOLN 125 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093412573","type":"CDM"},{"code":"00093412573","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PENICILLIN V POTASSIUM FOR SOLN 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093412773","type":"CDM"},{"code":"00093412773","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.31 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00093414564","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"00093414564","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.63 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00093414619","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"00093414619","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.63 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00093414645","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"00093414645","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.63 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00093414664","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"00093414664","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU CONC 1.25 MG/0.5ML (BASE EQUIV)","drug_information":{"unit":30.0,"type":"EA"},"code_information":[{"code":"Rx00093414756","type":"CDM"},{"code":"J7612","type":"HCPCS"},{"code":"00093414756","type":"NDC"}],"standard_charges":[{"gross_charge":221.15,"discounted_cash":77.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 125 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093415073","type":"CDM"},{"code":"00093415073","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 400 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093416176","type":"CDM"},{"code":"00093416176","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 125 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093417573","type":"CDM"},{"code":"00093417573","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093417773","type":"CDM"},{"code":"00093417773","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093423301","type":"CDM"},{"code":"00093423301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUMETANIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093423401","type":"CDM"},{"code":"00093423401","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093506001","type":"CDM"},{"code":"00093506001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093520701","type":"CDM"},{"code":"00093520701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROGESTERONE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093535301","type":"CDM"},{"code":"00093535301","type":"NDC"}],"standard_charges":[{"gross_charge":2.38,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OMEGA-3-ACID ETHYL ESTERS CAP 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093540189","type":"CDM"},{"code":"00093540189","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SILDENAFIL CITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093551798","type":"CDM"},{"code":"00093551798","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DUTASTERIDE CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093565556","type":"CDM"},{"code":"00093565556","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093574219","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00093574219","type":"NDC"}],"standard_charges":[{"gross_charge":2.68,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093574265","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00093574265","type":"NDC"}],"standard_charges":[{"gross_charge":2.67,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093585101","type":"CDM"},{"code":"00093585101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ESOMEPRAZOLE MAGNESIUM CAP DELAYED RELEASE 40 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093645156","type":"CDM"},{"code":"00093645156","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.25 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00093681519","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00093681519","type":"NDC"}],"standard_charges":[{"gross_charge":4.17,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.25 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00093681555","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00093681555","type":"NDC"}],"standard_charges":[{"gross_charge":2.94,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00093681619","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00093681619","type":"NDC"}],"standard_charges":[{"gross_charge":4.17,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00093681655","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00093681655","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00093681673","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00093681673","type":"NDC"}],"standard_charges":[{"gross_charge":12.18,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLARITHROMYCIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093715806","type":"CDM"},{"code":"00093715806","type":"NDC"}],"standard_charges":[{"gross_charge":5.07,"discounted_cash":1.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093716456","type":"CDM"},{"code":"00093716456","type":"NDC"}],"standard_charges":[{"gross_charge":8.84,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GLIMEPIRIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093725401","type":"CDM"},{"code":"00093725401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MIRTAZAPINE ORALLY DISINTEGRATING TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093730365","type":"CDM"},{"code":"00093730365","type":"NDC"}],"standard_charges":[{"gross_charge":2.72,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DESMOPRESSIN ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093731601","type":"CDM"},{"code":"00093731601","type":"NDC"}],"standard_charges":[{"gross_charge":5.34,"discounted_cash":1.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOPIRAMATE SPRINKLE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093733606","type":"CDM"},{"code":"00093733606","type":"NDC"}],"standard_charges":[{"gross_charge":1.85,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093738598","type":"CDM"},{"code":"00093738598","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 150 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093738656","type":"CDM"},{"code":"00093738656","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NIACIN TAB ER 500 MG (ANTIHYPERLIPIDEMIC)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093739298","type":"CDM"},{"code":"00093739298","type":"NDC"}],"standard_charges":[{"gross_charge":4.73,"discounted_cash":1.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093743156","type":"CDM"},{"code":"00093743156","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IRBESARTAN TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093746456","type":"CDM"},{"code":"00093746456","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CAPECITABINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093747489","type":"CDM"},{"code":"J8522","type":"HCPCS"},{"code":"00093747489","type":"NDC"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLYBURIDE MICRONIZED TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093803501","type":"CDM"},{"code":"00093803501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLYBURIDE TAB 1.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093834201","type":"CDM"},{"code":"00093834201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLYBURIDE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093834301","type":"CDM"},{"code":"00093834301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 600-42.9 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093867578","type":"CDM"},{"code":"00093867578","type":"NDC"}],"standard_charges":[{"gross_charge":2.67,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ACYCLOVIR TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093894701","type":"CDM"},{"code":"00093894701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 25 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093914701","type":"CDM"},{"code":"00093914701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLYBURIDE TAB 1.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093947753","type":"CDM"},{"code":"00093947753","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXEPIN HCL CONC 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00093961212","type":"CDM"},{"code":"00093961212","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SILVER NITRATE SOLN 0.5%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00093961413","type":"CDM"},{"code":"00093961413","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENOFIBRATE MICRONIZED CAP 134 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115052201","type":"CDM"},{"code":"00115052201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ACARBOSE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115115001","type":"CDM"},{"code":"00115115001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DANTROLENE SODIUM CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115443301","type":"CDM"},{"code":"00115443301","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"COLESTIPOL HCL TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115521116","type":"CDM"},{"code":"00115521116","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"COLESTIPOL HCL GRANULE PACKETS 5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115521218","type":"CDM"},{"code":"00115521218","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DIGOXIN TAB 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115981101","type":"CDM"},{"code":"00115981101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIGOXIN TAB 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115982201","type":"CDM"},{"code":"00115982201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HALOPERIDOL LACTATE ORAL CONC 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00121058104","type":"CDM"},{"code":"00121058104","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NORTRIPTYLINE HCL SOLN 10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121067816","type":"CDM"},{"code":"00121067816","type":"NDC"}],"standard_charges":[{"gross_charge":2.79,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00121087316","type":"CDM"},{"code":"00121087316","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121094540","type":"CDM"},{"code":"00121094540","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SUCRALFATE SUSP 1 GM/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121097410","type":"CDM"},{"code":"00121097410","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":3.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROMETHAZINE-DM SYRUP 6.25-15 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121107016","type":"CDM"},{"code":"00121107016","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00121115440","type":"CDM"},{"code":"00121115440","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121155010","type":"CDM"},{"code":"00121155010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121155040","type":"CDM"},{"code":"00121155040","type":"NDC"}],"standard_charges":[{"gross_charge":2.8,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121231615","type":"CDM"},{"code":"00121231615","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FLUOXETINE HCL SOLUTION 20 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00121472105","type":"CDM"},{"code":"00121472105","type":"NDC"}],"standard_charges":[{"gross_charge":3.2,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121478505","type":"CDM"},{"code":"00121478505","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LACOSAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00131247735","type":"CDM"},{"code":"00131247735","type":"NDC"}],"standard_charges":[{"gross_charge":16.6,"discounted_cash":5.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LACOSAMIDE ORAL SOLUTION 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00131541071","type":"CDM"},{"code":"00131541071","type":"NDC"}],"standard_charges":[{"gross_charge":12.76,"discounted_cash":4.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143908401","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00143908401","type":"NDC"}],"standard_charges":[{"gross_charge":287.34,"discounted_cash":100.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00143908901","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00143908901","type":"NDC"}],"standard_charges":[{"gross_charge":222.01,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143913501","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"00143913501","type":"NDC"}],"standard_charges":[{"gross_charge":666.44,"discounted_cash":233.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DOCETAXEL FOR INJ CONC 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143927901","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"00143927901","type":"NDC"}],"standard_charges":[{"gross_charge":666.44,"discounted_cash":233.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143933310","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00143933310","type":"NDC"}],"standard_charges":[{"gross_charge":93.43,"discounted_cash":32.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143933410","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00143933410","type":"NDC"}],"standard_charges":[{"gross_charge":93.45,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143935710","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00143935710","type":"NDC"}],"standard_charges":[{"gross_charge":95.55,"discounted_cash":33.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FOSAPREPITANT DIMEGLUMINE FOR IV INFUSION 150 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143938401","type":"CDM"},{"code":"J1453","type":"HCPCS"},{"code":"00143938401","type":"NDC"}],"standard_charges":[{"gross_charge":236.2,"discounted_cash":82.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CISPLATIN INJ 50 MG/50ML (1 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00143950401","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"00143950401","type":"NDC"}],"standard_charges":[{"gross_charge":258.29,"discounted_cash":90.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143950901","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143950901","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ETOPOSIDE INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143951001","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"00143951001","type":"NDC"}],"standard_charges":[{"gross_charge":264.18,"discounted_cash":92.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DAUNORUBICIN HCL IV SOLN 50 MG/10ML (BASE EQUIV)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00143955001","type":"CDM"},{"code":"J9150","type":"HCPCS"},{"code":"00143955001","type":"NDC"}],"standard_charges":[{"gross_charge":1629.72,"discounted_cash":570.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143959425","type":"CDM"},{"code":"00143959425","type":"NDC"}],"standard_charges":[{"gross_charge":93.41,"discounted_cash":32.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00143966010","type":"CDM"},{"code":"00143966010","type":"NDC"}],"standard_charges":[{"gross_charge":93.52,"discounted_cash":32.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143968301","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143968301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":33.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"IRINOTECAN HCL INJ 40 MG/2ML (20 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143970201","type":"CDM"},{"code":"J9206","type":"HCPCS"},{"code":"00143970201","type":"NDC"}],"standard_charges":[{"gross_charge":286.6,"discounted_cash":100.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143970310","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"00143970310","type":"NDC"}],"standard_charges":[{"gross_charge":94.15,"discounted_cash":32.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 50 MG/50ML (BASE EQUIVALENT)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00143970801","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00143970801","type":"NDC"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 10 MG/10ML (BASE EQUIVALENT)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00143971010","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00143971010","type":"NDC"}],"standard_charges":[{"gross_charge":96.73,"discounted_cash":33.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00143972001","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143972001","type":"NDC"}],"standard_charges":[{"gross_charge":242.45,"discounted_cash":84.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143972101","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143972101","type":"NDC"}],"standard_charges":[{"gross_charge":242.3,"discounted_cash":84.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CLONIDINE HCL INJ (FOR EPIDURAL INFUSION) 100 MCG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00143972401","type":"CDM"},{"code":"J0735","type":"HCPCS"},{"code":"00143972401","type":"NDC"}],"standard_charges":[{"gross_charge":103.11,"discounted_cash":36.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BENZTROPINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143972901","type":"CDM"},{"code":"J0515","type":"HCPCS"},{"code":"00143972901","type":"NDC"}],"standard_charges":[{"gross_charge":238.04,"discounted_cash":83.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BENZTROPINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143972905","type":"CDM"},{"code":"J0515","type":"HCPCS"},{"code":"00143972905","type":"NDC"}],"standard_charges":[{"gross_charge":128.36,"discounted_cash":44.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143973801","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00143973801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143975325","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00143975325","type":"NDC"}],"standard_charges":[{"gross_charge":94.43,"discounted_cash":33.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 125 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143975401","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00143975401","type":"NDC"}],"standard_charges":[{"gross_charge":99.16,"discounted_cash":34.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PENICILLIN V POTASSIUM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143983601","type":"CDM"},{"code":"00143983601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 1000 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143985101","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00143985101","type":"NDC"}],"standard_charges":[{"gross_charge":100.89,"discounted_cash":35.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 600-42.9 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143985375","type":"CDM"},{"code":"00143985375","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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":"Rx00143987310","type":"CDM"},{"code":"00143987310","type":"NDC"}],"standard_charges":[{"gross_charge":93.5,"discounted_cash":32.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00143987325","type":"CDM"},{"code":"00143987325","type":"NDC"}],"standard_charges":[{"gross_charge":94.36,"discounted_cash":33.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143987725","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"00143987725","type":"NDC"}],"standard_charges":[{"gross_charge":98.1,"discounted_cash":34.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 400 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143988701","type":"CDM"},{"code":"00143988701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 400 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143988775","type":"CDM"},{"code":"00143988775","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 125 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143988880","type":"CDM"},{"code":"00143988880","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLYBURIDE MICRONIZED TAB 1.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143991801","type":"CDM"},{"code":"00143991801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143992390","type":"CDM"},{"code":"J0688","type":"HCPCS"},{"code":"00143992390","type":"NDC"}],"standard_charges":[{"gross_charge":94.42,"discounted_cash":33.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEFOTAXIME SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143993101","type":"CDM"},{"code":"J0698","type":"HCPCS"},{"code":"00143993101","type":"NDC"}],"standard_charges":[{"gross_charge":95.3,"discounted_cash":33.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 200-28.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143998150","type":"CDM"},{"code":"00143998150","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00143998250","type":"CDM"},{"code":"00143998250","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143998391","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00143998391","type":"NDC"}],"standard_charges":[{"gross_charge":97.85,"discounted_cash":34.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00168000415","type":"CDM"},{"code":"00168000415","type":"NDC"}],"standard_charges":[{"gross_charge":3.71,"discounted_cash":1.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NYSTATIN OINT 100000 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00168000730","type":"CDM"},{"code":"00168000730","type":"NDC"}],"standard_charges":[{"gross_charge":29.11,"discounted_cash":10.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUOCINOLONE ACETONIDE OINT 0.025%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00168006415","type":"CDM"},{"code":"00168006415","type":"NDC"}],"standard_charges":[{"gross_charge":39.26,"discounted_cash":13.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NYSTATIN-TRIAMCINOLONE CREAM 100000-0.1 UNIT/GM-%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00168008130","type":"CDM"},{"code":"00168008130","type":"NDC"}],"standard_charges":[{"gross_charge":132.66,"discounted_cash":46.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLOBETASOL PROPIONATE OINT 0.05%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00168016230","type":"CDM"},{"code":"00168016230","type":"NDC"}],"standard_charges":[{"gross_charge":91.03,"discounted_cash":31.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIDOCAINE OINT 5%","drug_information":{"unit":35.44,"type":"GM"},"code_information":[{"code":"Rx00168020437","type":"CDM"},{"code":"00168020437","type":"NDC"}],"standard_charges":[{"gross_charge":318.05,"discounted_cash":111.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MUPIROCIN OINT 2%","drug_information":{"unit":22.0,"type":"GM"},"code_information":[{"code":"Rx00168035222","type":"CDM"},{"code":"00168035222","type":"NDC"}],"standard_charges":[{"gross_charge":44.71,"discounted_cash":15.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLOTRIMAZOLE W/ BETAMETHASONE LOTION 1-0.05%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00168037030","type":"CDM"},{"code":"00168037030","type":"NDC"}],"standard_charges":[{"gross_charge":172.12,"discounted_cash":60.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"INSULIN NPH (HUMAN) (ISOPHANE) INJ 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00169183411","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00169183411","type":"NDC"}],"standard_charges":[{"gross_charge":363.12,"discounted_cash":127.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"INSULIN DETEMIR INJ 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00169368712","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00169368712","type":"NDC"}],"standard_charges":[{"gross_charge":726.12,"discounted_cash":254.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIRAGLUTIDE SOLN PEN-INJECTOR 18 MG/3ML (6 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00169406012","type":"CDM"},{"code":"J3590","type":"HCPCS"},{"code":"00169406012","type":"NDC"}],"standard_charges":[{"gross_charge":2790.71,"discounted_cash":976.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"INSULIN DETEMIR SOLN PEN-INJECTOR 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00169643810","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00169643810","type":"NDC"}],"standard_charges":[{"gross_charge":576.5,"discounted_cash":201.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"INSULIN DETEMIR SOLN PEN-INJECTOR 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00169643910","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00169643910","type":"NDC"}],"standard_charges":[{"gross_charge":396.34,"discounted_cash":138.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"COAGULATION FACTOR VIIA (RECOMB) FOR INJ 2 MG (2000 MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00169720201","type":"CDM"},{"code":"J7189","type":"HCPCS"},{"code":"00169720201","type":"NDC"}],"standard_charges":[{"gross_charge":52436.16,"discounted_cash":18352.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"INSULIN ASPART INJ SOLN 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00169750111","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00169750111","type":"NDC"}],"standard_charges":[{"gross_charge":352.1,"discounted_cash":123.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ANTIHEMOPHILIC FACT RCMB (BD TRUNC-RFVIII) FOR INJ 1000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00169781001","type":"CDM"},{"code":"J7182","type":"HCPCS"},{"code":"00169781001","type":"NDC"}],"standard_charges":[{"gross_charge":9112.54,"discounted_cash":3189.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ANTIHEMOPHILIC FACT RCMB (BD TRUNC-RFVIII) FOR INJ 2000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00169782001","type":"CDM"},{"code":"J7182","type":"HCPCS"},{"code":"00169782001","type":"NDC"}],"standard_charges":[{"gross_charge":19367.82,"discounted_cash":6778.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LISINOPRIL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172375760","type":"CDM"},{"code":"00172375760","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ANAGRELIDE HCL CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172524160","type":"CDM"},{"code":"00172524160","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172541100","type":"CDM"},{"code":"00172541100","type":"NDC"}],"standard_charges":[{"gross_charge":13.13,"discounted_cash":4.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172541211","type":"CDM"},{"code":"00172541211","type":"NDC"}],"standard_charges":[{"gross_charge":3.88,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED ORAL SOLN 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00172731320","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00172731320","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIGOXIN TAB 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173024956","type":"CDM"},{"code":"00173024956","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFUROXIME SODIUM FOR INJ 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173035210","type":"CDM"},{"code":"J0697","type":"HCPCS"},{"code":"00173035210","type":"NDC"}],"standard_charges":[{"gross_charge":97.84,"discounted_cash":34.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EPOPROSTENOL SODIUM FOR INJ 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173051700","type":"CDM"},{"code":"J1325","type":"HCPCS"},{"code":"00173051700","type":"NDC"}],"standard_charges":[{"gross_charge":209.32,"discounted_cash":73.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SALMETEROL XINAFOATE AER POW BA 50 MCG/ACT (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173052000","type":"CDM"},{"code":"00173052000","type":"NDC"}],"standard_charges":[{"gross_charge":11.93,"discounted_cash":4.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SUMATRIPTAN NASAL SPRAY 5 MG/ACT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173052400","type":"CDM"},{"code":"00173052400","type":"NDC"}],"standard_charges":[{"gross_charge":127.41,"discounted_cash":44.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173073500","type":"CDM"},{"code":"00173073500","type":"NDC"}],"standard_charges":[{"gross_charge":47.31,"discounted_cash":16.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OMEGA-3-ACID ETHYL ESTERS CAP 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173078302","type":"CDM"},{"code":"00173078302","type":"NDC"}],"standard_charges":[{"gross_charge":3.36,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLYCINE DILUENT FOR INJECTION","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00173085702","type":"CDM"},{"code":"00173085702","type":"NDC"}],"standard_charges":[{"gross_charge":251.44,"discounted_cash":88.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185001001","type":"CDM"},{"code":"00185001001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185012901","type":"CDM"},{"code":"00185012901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUMETANIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185013001","type":"CDM"},{"code":"00185013001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185014409","type":"CDM"},{"code":"00185014409","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185041060","type":"CDM"},{"code":"00185041060","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185041560","type":"CDM"},{"code":"00185041560","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUDESONIDE DELAYED RELEASE PARTICLES CAP 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00186070210","type":"CDM"},{"code":"00186070210","type":"NDC"}],"standard_charges":[{"gross_charge":32.28,"discounted_cash":11.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TICAGRELOR TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00186077660","type":"CDM"},{"code":"00186077660","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":3.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00186108839","type":"CDM"},{"code":"00186108839","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00186109039","type":"CDM"},{"code":"00186109039","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 100 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00186109239","type":"CDM"},{"code":"00186109239","type":"NDC"}],"standard_charges":[{"gross_charge":2.52,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RIBAVIRIN FOR INHAL SOLN 6 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00187000714","type":"CDM"},{"code":"00187000714","type":"NDC"}],"standard_charges":[{"gross_charge":258374.84,"discounted_cash":90431.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIAZEPAM RECTAL GEL DELIVERY SYSTEM 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00187065820","type":"CDM"},{"code":"00187065820","type":"NDC"}],"standard_charges":[{"gross_charge":314.95,"discounted_cash":110.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00187073030","type":"CDM"},{"code":"00187073030","type":"NDC"}],"standard_charges":[{"gross_charge":110.58,"discounted_cash":38.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ACYCLOVIR OINT 5%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00187099395","type":"CDM"},{"code":"00187099395","type":"NDC"}],"standard_charges":[{"gross_charge":226.71,"discounted_cash":79.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PYRIDOSTIGMINE BROMIDE TAB ER 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00187301330","type":"CDM"},{"code":"00187301330","type":"NDC"}],"standard_charges":[{"gross_charge":61.98,"discounted_cash":21.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"WOUND DRESSINGS - EMULSION","drug_information":{"unit":90.0,"type":"GM"},"code_information":[{"code":"Rx00187511090","type":"CDM"},{"code":"00187511090","type":"NDC"}],"standard_charges":[{"gross_charge":83.43,"discounted_cash":29.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00206240801","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00206240801","type":"NDC"}],"standard_charges":[{"gross_charge":102.62,"discounted_cash":35.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00206410001","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00206410001","type":"NDC"}],"standard_charges":[{"gross_charge":142.64,"discounted_cash":49.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00206885508","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00206885508","type":"NDC"}],"standard_charges":[{"gross_charge":338.35,"discounted_cash":118.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 40.5 GM (36-4.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00206885910","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00206885910","type":"NDC"}],"standard_charges":[{"gross_charge":885.54,"discounted_cash":309.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228202710","type":"CDM"},{"code":"00228202710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALPRAZOLAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228203110","type":"CDM"},{"code":"00228203110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228253910","type":"CDM"},{"code":"00228253910","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228254010","type":"CDM"},{"code":"00228254010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228266711","type":"CDM"},{"code":"00228266711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228299611","type":"CDM"},{"code":"00228299611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB ER 24HR 6 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228364003","type":"CDM"},{"code":"00228364003","type":"NDC"}],"standard_charges":[{"gross_charge":9.01,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB ER 24HR 2 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228365803","type":"CDM"},{"code":"00228365803","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POTASSIUM IODIDE ORAL SOLN 1 GM/ML","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx00245000308","type":"CDM"},{"code":"00245000308","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CALCITONIN (SALMON) NASAL SOLN 200 UNIT/ACT","drug_information":{"unit":3.7,"type":"ML"},"code_information":[{"code":"Rx00245000835","type":"CDM"},{"code":"00245000835","type":"NDC"}],"standard_charges":[{"gross_charge":28.06,"discounted_cash":9.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"POTASSIUM BICARBONATE EFFER TAB 25 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245003989","type":"CDM"},{"code":"00245003989","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POTASSIUM CITRATE TAB ER 5 MEQ (540 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245007011","type":"CDM"},{"code":"00245007011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMIODARONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245014430","type":"CDM"},{"code":"00245014430","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245014789","type":"CDM"},{"code":"00245014789","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245021211","type":"CDM"},{"code":"00245021211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245021289","type":"CDM"},{"code":"00245021289","type":"NDC"}],"standard_charges":[{"gross_charge":4.17,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245036030","type":"CDM"},{"code":"00245036030","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METRONIDAZOLE VAGINAL GEL 0.75%","drug_information":{"unit":70.0,"type":"GM"},"code_information":[{"code":"Rx00245086070","type":"CDM"},{"code":"00245086070","type":"NDC"}],"standard_charges":[{"gross_charge":50.19,"discounted_cash":17.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DIAZOXIDE SUSP 50 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00254101019","type":"CDM"},{"code":"00254101019","type":"NDC"}],"standard_charges":[{"gross_charge":301.09,"discounted_cash":105.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LUBIPROSTONE CAP 8 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00254302802","type":"CDM"},{"code":"00254302802","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00264151031","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00264151031","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00264151032","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00264151032","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00264180031","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00264180031","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264180031","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00264180031","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264180032","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00264180032","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00264180032","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00264180032","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMINO ACID INFUSION 10%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264193310","type":"CDM"},{"code":"00264193310","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HETASTARCH (HES /0.7 OR /0.75) 6% IN NACL 0.9% IV SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264196510","type":"CDM"},{"code":"00264196510","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"WATER FOR IRRIGATION, STERILE IRRIGATION SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00264210100","type":"CDM"},{"code":"00264210100","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"WATER FOR IRRIGATION, STERILE IRRIGATION SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264210110","type":"CDM"},{"code":"00264210110","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"WATER FOR IRRIGATION, STERILE IRRIGATION SOLN","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00264210150","type":"CDM"},{"code":"00264210150","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00264220100","type":"CDM"},{"code":"00264220100","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264220110","type":"CDM"},{"code":"00264220110","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MEROPENEM & SODIUM CHLORIDE 0.9% FOR IV SOLN 500 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00264318311","type":"CDM"},{"code":"J2184","type":"HCPCS"},{"code":"00264318311","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFEPIME HCL FOR IV SOLN 1 GM AND DEXTROSE 5% (50 ML)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00264319311","type":"CDM"},{"code":"J0703","type":"HCPCS"},{"code":"00264319311","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264580210","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"00264580210","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00264751000","type":"CDM"},{"code":"J7070","type":"HCPCS"},{"code":"00264751000","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264751010","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00264751010","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264751020","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00264751020","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264752020","type":"CDM"},{"code":"00264752020","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MANNITOL IV SOLN 20%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264757810","type":"CDM"},{"code":"J2151","type":"HCPCS"},{"code":"00264757810","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00264761000","type":"CDM"},{"code":"J7042","type":"HCPCS"},{"code":"00264761000","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264761000","type":"CDM"},{"code":"J7042","type":"HCPCS"},{"code":"00264761000","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264761010","type":"CDM"},{"code":"J7042","type":"HCPCS"},{"code":"00264761010","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264761020","type":"CDM"},{"code":"J7042","type":"HCPCS"},{"code":"00264761020","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00264761200","type":"CDM"},{"code":"00264761200","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264761210","type":"CDM"},{"code":"00264761210","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264761220","type":"CDM"},{"code":"00264761220","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00264761600","type":"CDM"},{"code":"00264761600","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE 10% W/ SODIUM CHLORIDE 0.2%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264762320","type":"CDM"},{"code":"00264762320","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00264763500","type":"CDM"},{"code":"00264763500","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00264764500","type":"CDM"},{"code":"00264764500","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ELECTROLYTE-S (PH 7.4) SOLUTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00264770700","type":"CDM"},{"code":"00264770700","type":"NDC"}],"standard_charges":[{"gross_charge":97.42,"discounted_cash":34.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE 5% IN LACTATED RINGERS","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00264775100","type":"CDM"},{"code":"J7121","type":"HCPCS"},{"code":"00264775100","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE 5% IN LACTATED RINGERS","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264775110","type":"CDM"},{"code":"J7121","type":"HCPCS"},{"code":"00264775110","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264780000","type":"CDM"},{"code":"J7030","type":"HCPCS"},{"code":"00264780000","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00264780000","type":"CDM"},{"code":"J7030","type":"HCPCS"},{"code":"00264780000","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264780010","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"00264780010","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264780020","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00264780020","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00264780200","type":"CDM"},{"code":"00264780200","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264780210","type":"CDM"},{"code":"00264780210","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00264785000","type":"CDM"},{"code":"00264785000","type":"NDC"}],"standard_charges":[{"gross_charge":98.25,"discounted_cash":34.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264785010","type":"CDM"},{"code":"00264785010","type":"NDC"}],"standard_charges":[{"gross_charge":95.75,"discounted_cash":33.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264785020","type":"CDM"},{"code":"00264785020","type":"NDC"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":33.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMINO ACID INFUSION 10%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00264901055","type":"CDM"},{"code":"00264901055","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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":"Rx00264987210","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00264987210","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIATRIZOATE MEGLUMINE URETHRAL SOLN 30%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00270014960","type":"CDM"},{"code":"Q9958","type":"HCPCS"},{"code":"00270014960","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"IOPAMIDOL IV SOLN 76%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00270131635","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131635","type":"NDC"}],"standard_charges":[{"gross_charge":116.1,"discounted_cash":40.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IOPAMIDOL IV SOLN 76%","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00270131641","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131641","type":"NDC"}],"standard_charges":[{"gross_charge":482.4,"discounted_cash":168.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IOPAMIDOL INJ 41%","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00270141125","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00270141125","type":"NDC"}],"standard_charges":[{"gross_charge":138.18,"discounted_cash":48.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ROFLUMILAST TAB 500 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310009530","type":"CDM"},{"code":"00310009530","type":"NDC"}],"standard_charges":[{"gross_charge":18.86,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310027839","type":"CDM"},{"code":"00310027839","type":"NDC"}],"standard_charges":[{"gross_charge":8.97,"discounted_cash":3.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB ER 24HR 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310028039","type":"CDM"},{"code":"00310028039","type":"NDC"}],"standard_charges":[{"gross_charge":11.44,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB ER 24HR 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310028060","type":"CDM"},{"code":"00310028060","type":"NDC"}],"standard_charges":[{"gross_charge":11.29,"discounted_cash":3.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00310072010","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"00310072010","type":"NDC"}],"standard_charges":[{"gross_charge":9258.88,"discounted_cash":3240.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310075139","type":"CDM"},{"code":"00310075139","type":"NDC"}],"standard_charges":[{"gross_charge":12.11,"discounted_cash":4.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310075290","type":"CDM"},{"code":"00310075290","type":"NDC"}],"standard_charges":[{"gross_charge":12.77,"discounted_cash":4.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"WATER FOR IRRIGATION, STERILE IRRIGATION SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338000402","type":"CDM"},{"code":"00338000402","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00338001701","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001701","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338001703","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001703","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338001704","type":"CDM"},{"code":"J7070","type":"HCPCS"},{"code":"00338001704","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338001741","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001741","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338002302","type":"CDM"},{"code":"00338002302","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338002304","type":"CDM"},{"code":"00338002304","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338004303","type":"CDM"},{"code":"00338004303","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338004304","type":"CDM"},{"code":"00338004304","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338004304","type":"CDM"},{"code":"00338004304","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":3000.0,"type":"ML"},"code_information":[{"code":"Rx00338004727","type":"CDM"},{"code":"00338004727","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338004746","type":"CDM"},{"code":"00338004746","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":3000.0,"type":"ML"},"code_information":[{"code":"Rx00338004747","type":"CDM"},{"code":"00338004747","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338004802","type":"CDM"},{"code":"00338004802","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00338004910","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004910","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338004911","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004911","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338004918","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004918","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338004918","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004918","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338004938","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004938","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"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: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":3000.0,"type":"ML"},"code_information":[{"code":"Rx00338005047","type":"CDM"},{"code":"00338005047","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338006230","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338006230","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338008504","type":"CDM"},{"code":"00338008504","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338008904","type":"CDM"},{"code":"J7042","type":"HCPCS"},{"code":"00338008904","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338008904","type":"CDM"},{"code":"J7042","type":"HCPCS"},{"code":"00338008904","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NOREPINEPHRINE-DEXTROSE IV SOLUTION 4 MG/250ML-5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338011220","type":"CDM"},{"code":"00338011220","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL-DEXTROSE IV SOLN 1.25 GM/250ML-5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338012204","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00338012204","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL-DEXTROSE IV SOLN 1.5 GM/300ML-5%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00338012404","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00338012404","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE 5% IN LACTATED RINGERS","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338012504","type":"CDM"},{"code":"J7121","type":"HCPCS"},{"code":"00338012504","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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":"Rx00338022104","type":"CDM"},{"code":"00338022104","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00338022104","type":"CDM"},{"code":"00338022104","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MANNITOL IV SOLN 20%","drug_information":{"unit":62.5,"type":"ML"},"code_information":[{"code":"Rx00338035703","type":"CDM"},{"code":"J2151","type":"HCPCS"},{"code":"00338035703","type":"NDC"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"},{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00338042413","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00338042413","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00338042418","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00338042418","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GENTAMICIN IN SALINE INJ 1 MG/ML","drug_information":{"unit":133.333,"type":"ML"},"code_information":[{"code":"Rx00338050548","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"00338050548","type":"NDC"}],"standard_charges":[{"gross_charge":243.83,"discounted_cash":85.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY) IV EMULSION 20%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338051914","type":"CDM"},{"code":"00338051914","type":"NDC"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":142.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY) IV EMULSION 20%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00338051958","type":"CDM"},{"code":"00338051958","type":"NDC"}],"standard_charges":[{"gross_charge":417.6,"discounted_cash":146.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338055111","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338055111","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338055118","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338055118","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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":"Rx00338066304","type":"CDM"},{"code":"00338066304","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00338066904","type":"CDM"},{"code":"00338066904","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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":"Rx00338067304","type":"CDM"},{"code":"00338067304","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00338067504","type":"CDM"},{"code":"00338067504","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L (0.15%) IN DEXTROSE 5% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338068304","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00338068304","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00338069104","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00338069104","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L (0.15%) IN D5W LACTATED RINGERS","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338081104","type":"CDM"},{"code":"00338081104","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOPAMINE INJ 1.6 MG/ML IN D5W","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":102.5,"discounted_cash":35.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"},{"gross_charge":249.75,"discounted_cash":87.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DOBUTAMINE IN DEXTROSE 5% INJ 1 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338107302","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00338107302","type":"NDC"}],"standard_charges":[{"gross_charge":248.25,"discounted_cash":86.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOBUTAMINE INJ 2 MG/ML IN D5W","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338107502","type":"CDM"},{"code":"00338107502","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMINO ACID INFUSION 10%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338113003","type":"CDM"},{"code":"00338113003","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL-DEXTROSE IV SOLN 1 GM/200ML-5%","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00338355248","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00338355248","type":"NDC"}],"standard_charges":[{"gross_charge":417.6,"discounted_cash":146.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338381450","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00338381450","type":"NDC"}],"standard_charges":[{"gross_charge":246.55,"discounted_cash":86.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IFOSFAMIDE FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00338399101","type":"CDM"},{"code":"J9208","type":"HCPCS"},{"code":"00338399101","type":"NDC"}],"standard_charges":[{"gross_charge":742.17,"discounted_cash":259.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FIBRIN SEALANT COMPONENT KIT 10 ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00338430310","type":"CDM"},{"code":"00338430310","type":"NDC"}],"standard_charges":[{"gross_charge":1095.03,"discounted_cash":383.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338954302","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338954302","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338954303","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"00338954303","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338954304","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"00338954304","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338954305","type":"CDM"},{"code":"J7030","type":"HCPCS"},{"code":"00338954305","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN NACL 0.9% IV SOLN 900 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338955324","type":"CDM"},{"code":"J0737","type":"HCPCS"},{"code":"00338955324","type":"NDC"}],"standard_charges":[{"gross_charge":246.55,"discounted_cash":86.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FIBRIN SEALANT COMPONENT SOLUTION","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00338956001","type":"CDM"},{"code":"00338956001","type":"NDC"}],"standard_charges":[{"gross_charge":49.95,"discounted_cash":17.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FIBRIN SEALANT COMPONENT SOLUTION","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00338956401","type":"CDM"},{"code":"00338956401","type":"NDC"}],"standard_charges":[{"gross_charge":167.49,"discounted_cash":58.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FIBRIN SEALANT COMPONENT SOLUTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00338956801","type":"CDM"},{"code":"00338956801","type":"NDC"}],"standard_charges":[{"gross_charge":1027.53,"discounted_cash":359.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD IN DEX IV SOLN 2-0.25GM/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338963201","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00338963201","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD IN DEX IV SOLN 2-0.25GM/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338963224","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00338963224","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD IN DEX IV SOL 3-0.375GM/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338963624","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00338963624","type":"NDC"}],"standard_charges":[{"gross_charge":245.5,"discounted_cash":85.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378001801","type":"CDM"},{"code":"00378001801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TAMOXIFEN CITRATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378014491","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00378014491","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378022877","type":"CDM"},{"code":"00378022877","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378022893","type":"CDM"},{"code":"00378022893","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378041501","type":"CDM"},{"code":"00378041501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378047301","type":"CDM"},{"code":"00378047301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PRAZOSIN HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378110101","type":"CDM"},{"code":"00378110101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378113401","type":"CDM"},{"code":"00378113401","type":"NDC"}],"standard_charges":[{"gross_charge":2.49,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378130001","type":"CDM"},{"code":"00378130001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TRIAMTERENE & HYDROCHLOROTHIAZIDE TAB 37.5-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378135201","type":"CDM"},{"code":"00378135201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESTRADIOL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378145401","type":"CDM"},{"code":"00378145401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378156001","type":"CDM"},{"code":"00378156001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 88 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378180701","type":"CDM"},{"code":"00378180701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 112 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378181101","type":"CDM"},{"code":"00378181101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 150 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378181577","type":"CDM"},{"code":"00378181577","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 175 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378181701","type":"CDM"},{"code":"00378181701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 137 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378182301","type":"CDM"},{"code":"00378182301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378201577","type":"CDM"},{"code":"00378201577","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LISINOPRIL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378207201","type":"CDM"},{"code":"00378207201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NISOLDIPINE TAB ER 24HR 17 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378209701","type":"CDM"},{"code":"00378209701","type":"NDC"}],"standard_charges":[{"gross_charge":8.05,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ACARBOSE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378282077","type":"CDM"},{"code":"00378282077","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"REPAGLINIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378312201","type":"CDM"},{"code":"00378312201","type":"NDC"}],"standard_charges":[{"gross_charge":3.73,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ETOPOSIDE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378326694","type":"CDM"},{"code":"J8560","type":"HCPCS"},{"code":"00378326694","type":"NDC"}],"standard_charges":[{"gross_charge":119.04,"discounted_cash":41.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ESTRADIOL TD PATCH WEEKLY 0.075 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378335116","type":"CDM"},{"code":"00378335116","type":"NDC"}],"standard_charges":[{"gross_charge":25.89,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378340293","type":"CDM"},{"code":"00378340293","type":"NDC"}],"standard_charges":[{"gross_charge":8.89,"discounted_cash":3.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RIZATRIPTAN BENZOATE ORAL DISINTEGRATING TAB 10 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378370259","type":"CDM"},{"code":"00378370259","type":"NDC"}],"standard_charges":[{"gross_charge":7.77,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378385577","type":"CDM"},{"code":"00378385577","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378385777","type":"CDM"},{"code":"00378385777","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378395277","type":"CDM"},{"code":"00378395277","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378402401","type":"CDM"},{"code":"00378402401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MYCOPHENOLATE SODIUM TAB DR 180 MG (MYCOPHENOLIC ACID EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378420178","type":"CDM"},{"code":"J7518","type":"HCPCS"},{"code":"00378420178","type":"NDC"}],"standard_charges":[{"gross_charge":5.03,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXEPIN HCL CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378425001","type":"CDM"},{"code":"00378425001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378427593","type":"CDM"},{"code":"00378427593","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378563159","type":"CDM"},{"code":"00378563159","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VALSARTAN TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378581477","type":"CDM"},{"code":"00378581477","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL CAP ER 12HR 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378609001","type":"CDM"},{"code":"00378609001","type":"NDC"}],"standard_charges":[{"gross_charge":3.98,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL CAP ER 12HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378612001","type":"CDM"},{"code":"00378612001","type":"NDC"}],"standard_charges":[{"gross_charge":5.27,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METOLAZONE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378617201","type":"CDM"},{"code":"00378617201","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378661001","type":"CDM"},{"code":"00378661001","type":"NDC"}],"standard_charges":[{"gross_charge":3.27,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378668877","type":"CDM"},{"code":"00378668877","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378668977","type":"CDM"},{"code":"00378668977","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ZONISAMIDE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378672501","type":"CDM"},{"code":"00378672501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 1.25 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00378699298","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"00378699298","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU CONC 1.25 MG/0.5ML (BASE EQUIV)","drug_information":{"unit":30.0,"type":"EA"},"code_information":[{"code":"Rx00378699393","type":"CDM"},{"code":"J7612","type":"HCPCS"},{"code":"00378699393","type":"NDC"}],"standard_charges":[{"gross_charge":209.16,"discounted_cash":73.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00378699889","type":"CDM"},{"code":"00378699889","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OLMESARTAN MEDOXOMIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378701293","type":"CDM"},{"code":"00378701293","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 1.25 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00378705852","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"00378705852","type":"NDC"}],"standard_charges":[{"gross_charge":1.85,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378710077","type":"CDM"},{"code":"00378710077","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"IPRATROPIUM BROMIDE INHAL SOLN 0.02%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00378797052","type":"CDM"},{"code":"J7644","type":"HCPCS"},{"code":"00378797052","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ACYCLOVIR OINT 5%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00378870006","type":"CDM"},{"code":"00378870006","type":"NDC"}],"standard_charges":[{"gross_charge":103.14,"discounted_cash":36.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYCLOSPORINE (OPHTH) EMULSION 0.05%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378876058","type":"CDM"},{"code":"00378876058","type":"NDC"}],"standard_charges":[{"gross_charge":5.23,"discounted_cash":1.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYCLOSPORINE (OPHTH) EMULSION 0.05%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378876098","type":"CDM"},{"code":"00378876098","type":"NDC"}],"standard_charges":[{"gross_charge":3.63,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.2 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378910416","type":"CDM"},{"code":"00378910416","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 12 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378911916","type":"CDM"},{"code":"00378911916","type":"NDC"}],"standard_charges":[{"gross_charge":23.83,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378912116","type":"CDM"},{"code":"00378912116","type":"NDC"}],"standard_charges":[{"gross_charge":9.91,"discounted_cash":3.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378912416","type":"CDM"},{"code":"00378912416","type":"NDC"}],"standard_charges":[{"gross_charge":38.31,"discounted_cash":13.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00378967160","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"00378967160","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.63 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00378968144","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"00378968144","type":"NDC"}],"standard_charges":[{"gross_charge":7.48,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ORAL VEHICLES - SYRUP","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00395009016","type":"CDM"},{"code":"00395009016","type":"NDC"}],"standard_charges":[{"gross_charge":23.41,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406036762","type":"CDM"},{"code":"00406036762","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406052323","type":"CDM"},{"code":"00406052323","type":"NDC"}],"standard_charges":[{"gross_charge":2.57,"discounted_cash":0.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406833062","type":"CDM"},{"code":"00406833062","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406910076","type":"CDM"},{"code":"00406910076","type":"NDC"}],"standard_charges":[{"gross_charge":38.44,"discounted_cash":13.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 75 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406917576","type":"CDM"},{"code":"00406917576","type":"NDC"}],"standard_charges":[{"gross_charge":27.92,"discounted_cash":9.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENTANYL CITRATE LOZENGE ON A HANDLE 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406920230","type":"CDM"},{"code":"00406920230","type":"NDC"}],"standard_charges":[{"gross_charge":13.39,"discounted_cash":4.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLOMIPRAMINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406990603","type":"CDM"},{"code":"00406990603","type":"NDC"}],"standard_charges":[{"gross_charge":41.3,"discounted_cash":14.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IMIPRAMINE PAMOATE CAP 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406993103","type":"CDM"},{"code":"00406993103","type":"NDC"}],"standard_charges":[{"gross_charge":16.55,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IOHEXOL INJ 240 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00407141220","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141220","type":"NDC"}],"standard_charges":[{"gross_charge":97.86,"discounted_cash":34.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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":"Rx00409000101","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409000101","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00409000125","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409000125","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409000710","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409000710","type":"NDC"}],"standard_charges":[{"gross_charge":93.3,"discounted_cash":32.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409014701","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409014701","type":"NDC"}],"standard_charges":[{"gross_charge":93.32,"discounted_cash":32.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409014710","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409014710","type":"NDC"}],"standard_charges":[{"gross_charge":93.32,"discounted_cash":32.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GEMCITABINE HCL INJ 1 GM/26.3ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":26.3,"type":"ML"},"code_information":[{"code":"Rx00409018101","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"00409018101","type":"NDC"}],"standard_charges":[{"gross_charge":409.35,"discounted_cash":143.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GEMCITABINE HCL INJ 200 MG/5.26ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":5.26,"type":"ML"},"code_information":[{"code":"Rx00409018301","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"00409018301","type":"NDC"}],"standard_charges":[{"gross_charge":286.13,"discounted_cash":100.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 10 MG/10ML (BASE EQUIVALENT)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409021210","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00409021210","type":"NDC"}],"standard_charges":[{"gross_charge":96.73,"discounted_cash":33.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00409100520","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409100520","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MEPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 1.5%","drug_information":{"unit":1.333333333333333333,"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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ATRACURIUM BESYLATE PRESERVATIVE FREE (PF) IV SOLN 50 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409110901","type":"CDM"},{"code":"00409110901","type":"NDC"}],"standard_charges":[{"gross_charge":95.55,"discounted_cash":33.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409113403","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409113403","type":"NDC"}],"standard_charges":[{"gross_charge":182.21,"discounted_cash":63.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409114402","type":"CDM"},{"code":"00409114402","type":"NDC"}],"standard_charges":[{"gross_charge":94.53,"discounted_cash":33.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409114405","type":"CDM"},{"code":"00409114405","type":"NDC"}],"standard_charges":[{"gross_charge":95.07,"discounted_cash":33.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409115909","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409115909","type":"NDC"}],"standard_charges":[{"gross_charge":93.45,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409117101","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00409117101","type":"NDC"}],"standard_charges":[{"gross_charge":95.16,"discounted_cash":33.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 50 MG/10ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409117102","type":"CDM"},{"code":"00409117102","type":"NDC"}],"standard_charges":[{"gross_charge":93.7,"discounted_cash":32.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MEPERIDINE HCL INJ 50 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409117803","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00409117803","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MEPERIDINE HCL INJ 50 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409117830","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00409117830","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"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: JVCPCT LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409127332","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"00409127332","type":"NDC"}],"standard_charges":[{"gross_charge":158.29,"discounted_cash":55.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409128303","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409128303","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409128317","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409128317","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409128337","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409128337","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MEPERIDINE HCL INJ 50 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409141811","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00409141811","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409155930","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409155930","type":"NDC"}],"standard_charges":[{"gross_charge":93.98,"discounted_cash":32.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409163110","type":"CDM"},{"code":"00409163110","type":"NDC"}],"standard_charges":[{"gross_charge":129.58,"discounted_cash":45.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409163249","type":"CDM"},{"code":"00409163249","type":"NDC"}],"standard_charges":[{"gross_charge":97.36,"discounted_cash":34.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409174910","type":"CDM"},{"code":"00409174910","type":"NDC"}],"standard_charges":[{"gross_charge":96.22,"discounted_cash":33.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.75% IN DEXTROSE INJ 8.25%","drug_information":{"unit":0.6666666666666666667,"type":"ML"},"code_information":[{"code":"Rx00409176102","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409176102","type":"NDC"}],"standard_charges":[{"gross_charge":94.64,"discounted_cash":33.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 0.5 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409180501","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409180501","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 0.5 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409180510","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409180510","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409189003","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189003","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 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: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 4 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409189101","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189101","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00409189103","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189103","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00409189123","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189123","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ADENOSINE IV SOLN 3 MG/ML (DIAGNOSTIC)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409193201","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"00409193201","type":"NDC"}],"standard_charges":[{"gross_charge":321.88,"discounted_cash":112.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DOBUTAMINE HCL INJ 12.5 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409202520","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00409202520","type":"NDC"}],"standard_charges":[{"gross_charge":97.43,"discounted_cash":34.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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":"Rx00409230849","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230849","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEFEROXAMINE MESYLATE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409233610","type":"CDM"},{"code":"J0895","type":"HCPCS"},{"code":"00409233610","type":"NDC"}],"standard_charges":[{"gross_charge":101.41,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DOBUTAMINE IN DEXTROSE 5% INJ 1 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409234631","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00409234631","type":"NDC"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":86.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOBUTAMINE IN DEXTROSE 5% INJ 1 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409234632","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00409234632","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOBUTAMINE INJ 2 MG/ML IN D5W","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409234732","type":"CDM"},{"code":"00409234732","type":"NDC"}],"standard_charges":[{"gross_charge":414.7,"discounted_cash":145.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOBUTAMINE INJ 2 MG/ML IN D5W","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409234733","type":"CDM"},{"code":"00409234733","type":"NDC"}],"standard_charges":[{"gross_charge":249.75,"discounted_cash":87.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409263425","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409263425","type":"NDC"}],"standard_charges":[{"gross_charge":127.96,"discounted_cash":44.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409272330","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409272330","type":"NDC"}],"standard_charges":[{"gross_charge":93.44,"discounted_cash":32.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 5% IV SOLN 20 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409277623","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00409277623","type":"NDC"}],"standard_charges":[{"gross_charge":163.52,"discounted_cash":57.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"},{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE INJ 0.5% W/ EPINEPHRINE-1:200000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409317701","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409317701","type":"NDC"}],"standard_charges":[{"gross_charge":93.29,"discounted_cash":32.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409317801","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409317801","type":"NDC"}],"standard_charges":[{"gross_charge":93.3,"discounted_cash":32.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409317802","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409317802","type":"NDC"}],"standard_charges":[{"gross_charge":93.35,"discounted_cash":32.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409318301","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409318301","type":"NDC"}],"standard_charges":[{"gross_charge":93.93,"discounted_cash":32.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 2 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00409336510","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409336510","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 2 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00409336511","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409336511","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00409337504","type":"CDM"},{"code":"00409337504","type":"NDC"}],"standard_charges":[{"gross_charge":97.37,"discounted_cash":34.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00409338302","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00409338302","type":"NDC"}],"standard_charges":[{"gross_charge":97.1,"discounted_cash":33.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00409338513","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00409338513","type":"NDC"}],"standard_charges":[{"gross_charge":98.47,"discounted_cash":34.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409341421","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"00409341421","type":"NDC"}],"standard_charges":[{"gross_charge":93.82,"discounted_cash":32.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409350501","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00409350501","type":"NDC"}],"standard_charges":[{"gross_charge":98.64,"discounted_cash":34.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409350601","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00409350601","type":"NDC"}],"standard_charges":[{"gross_charge":121.48,"discounted_cash":42.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IMIPENEM-CILASTATIN INTRAVENOUS FOR SOLN 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409350801","type":"CDM"},{"code":"J0743","type":"HCPCS"},{"code":"00409350801","type":"NDC"}],"standard_charges":[{"gross_charge":97.87,"discounted_cash":34.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.75% IN DEXTROSE INJ 8.25%","drug_information":{"unit":0.6666666666666666667,"type":"ML"},"code_information":[{"code":"Rx00409361301","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409361301","type":"NDC"}],"standard_charges":[{"gross_charge":93.9,"discounted_cash":32.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 15 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409379301","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"00409379301","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.3333333333333333333,"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: JVCPCT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409379549","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"00409379549","type":"NDC"}],"standard_charges":[{"gross_charge":93.51,"discounted_cash":32.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE IM INJ 60 MG/2ML (30 MG/ML)","drug_information":{"unit":0.3333333333333333333,"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: JVCPCT 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: JVCPCT 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: JVCPCT 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":242.2,"discounted_cash":84.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"},{"gross_charge":94.95,"discounted_cash":33.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 900 MG/6ML","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx00409405201","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00409405201","type":"NDC"}],"standard_charges":[{"gross_charge":97.19,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409426401","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409426401","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427701","type":"CDM"},{"code":"00409427701","type":"NDC"}],"standard_charges":[{"gross_charge":93.36,"discounted_cash":32.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409428201","type":"CDM"},{"code":"00409428201","type":"NDC"}],"standard_charges":[{"gross_charge":93.69,"discounted_cash":32.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409428211","type":"CDM"},{"code":"00409428211","type":"NDC"}],"standard_charges":[{"gross_charge":93.69,"discounted_cash":32.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx00409468802","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00409468802","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409468802","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00409468802","type":"NDC"}],"standard_charges":[{"gross_charge":243.8,"discounted_cash":85.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00409468802","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00409468802","type":"NDC"}],"standard_charges":[{"gross_charge":247.1,"discounted_cash":86.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409468822","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00409468822","type":"NDC"}],"standard_charges":[{"gross_charge":247.1,"discounted_cash":86.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx00409468828","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00409468828","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409468828","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00409468828","type":"NDC"}],"standard_charges":[{"gross_charge":245.2,"discounted_cash":85.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00409468828","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00409468828","type":"NDC"}],"standard_charges":[{"gross_charge":249.9,"discounted_cash":87.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL LARYNGOTRACHEAL SOLN 4%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409469801","type":"CDM"},{"code":"00409469801","type":"NDC"}],"standard_charges":[{"gross_charge":7.13,"discounted_cash":2.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409471302","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00409471302","type":"NDC"}],"standard_charges":[{"gross_charge":93.4,"discounted_cash":32.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409477601","type":"CDM"},{"code":"00409477601","type":"NDC"}],"standard_charges":[{"gross_charge":95.15,"discounted_cash":33.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409477750","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409477750","type":"NDC"}],"standard_charges":[{"gross_charge":241.7,"discounted_cash":84.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00409477750","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409477750","type":"NDC"}],"standard_charges":[{"gross_charge":242.9,"discounted_cash":85.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409488820","type":"CDM"},{"code":"00409488820","type":"NDC"}],"standard_charges":[{"gross_charge":95.45,"discounted_cash":33.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409490234","type":"CDM"},{"code":"00409490234","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409490264","type":"CDM"},{"code":"00409490264","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00409490411","type":"CDM"},{"code":"00409490411","type":"NDC"}],"standard_charges":[{"gross_charge":96.64,"discounted_cash":33.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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":"Rx00409491134","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"00409491134","type":"NDC"}],"standard_charges":[{"gross_charge":99.59,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00409492120","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"00409492120","type":"NDC"}],"standard_charges":[{"gross_charge":93.7,"discounted_cash":32.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00409492134","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"00409492134","type":"NDC"}],"standard_charges":[{"gross_charge":93.7,"discounted_cash":32.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409508211","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00409508211","type":"NDC"}],"standard_charges":[{"gross_charge":243.25,"discounted_cash":85.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":243.25,"discounted_cash":85.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"},{"gross_charge":96.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409508252","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00409508252","type":"NDC"}],"standard_charges":[{"gross_charge":96.27,"discounted_cash":33.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409573801","type":"CDM"},{"code":"00409573801","type":"NDC"}],"standard_charges":[{"gross_charge":95.02,"discounted_cash":33.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00409610204","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610204","type":"NDC"}],"standard_charges":[{"gross_charge":95.87,"discounted_cash":33.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409610210","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610210","type":"NDC"}],"standard_charges":[{"gross_charge":98.47,"discounted_cash":34.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"WATER FOR IRRIGATION, STERILE IRRIGATION SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409613903","type":"CDM"},{"code":"00409613903","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ERYTHROMYCIN LACTOBIONATE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409648201","type":"CDM"},{"code":"J1364","type":"HCPCS"},{"code":"00409648201","type":"NDC"}],"standard_charges":[{"gross_charge":618.93,"discounted_cash":216.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409650949","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409650949","type":"NDC"}],"standard_charges":[{"gross_charge":205.29,"discounted_cash":71.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 750 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409653102","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409653102","type":"NDC"}],"standard_charges":[{"gross_charge":102.11,"discounted_cash":35.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409653501","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409653501","type":"NDC"}],"standard_charges":[{"gross_charge":98.2,"discounted_cash":34.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409662514","type":"CDM"},{"code":"00409662514","type":"NDC"}],"standard_charges":[{"gross_charge":97.75,"discounted_cash":34.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409663714","type":"CDM"},{"code":"00409663714","type":"NDC"}],"standard_charges":[{"gross_charge":101.25,"discounted_cash":35.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409665305","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00409665305","type":"NDC"}],"standard_charges":[{"gross_charge":97.89,"discounted_cash":34.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409669501","type":"CDM"},{"code":"00409669501","type":"NDC"}],"standard_charges":[{"gross_charge":95.79,"discounted_cash":33.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MAGNESIUM SULFATE IN DEXTROSE 5% IV SOLN 1 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409672723","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409672723","type":"NDC"}],"standard_charges":[{"gross_charge":241.6,"discounted_cash":84.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409710002","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409710002","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409710066","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409710066","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409710067","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409710067","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409710166","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409710166","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409710167","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409710167","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 70%","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00409712007","type":"CDM"},{"code":"00409712007","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733604","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733604","type":"NDC"}],"standard_charges":[{"gross_charge":97.14,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409751766","type":"CDM"},{"code":"00409751766","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GENTAMICIN IN SALINE INJ 1.6 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409788313","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"00409788313","type":"NDC"}],"standard_charges":[{"gross_charge":244.45,"discounted_cash":85.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409793003","type":"CDM"},{"code":"00409793003","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"WATER FOR IRRIGATION, STERILE IRRIGATION SOLN","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00409797307","type":"CDM"},{"code":"00409797307","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":300.0,"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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409799009","type":"CDM"},{"code":"00409799009","type":"NDC"}],"standard_charges":[{"gross_charge":98.25,"discounted_cash":34.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POTASSIUM ACETATE INJ 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409818301","type":"CDM"},{"code":"00409818301","type":"NDC"}],"standard_charges":[{"gross_charge":98.19,"discounted_cash":34.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409904201","type":"CDM"},{"code":"00409904201","type":"NDC"}],"standard_charges":[{"gross_charge":94.96,"discounted_cash":33.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409904501","type":"CDM"},{"code":"00409904501","type":"NDC"}],"standard_charges":[{"gross_charge":94.2,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409904601","type":"CDM"},{"code":"00409904601","type":"NDC"}],"standard_charges":[{"gross_charge":97.2,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409909418","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909418","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","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: JVCPCT LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409909425","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909425","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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":"Rx00409913705","type":"CDM"},{"code":"00409913705","type":"NDC"}],"standard_charges":[{"gross_charge":98.13,"discounted_cash":34.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00409913711","type":"CDM"},{"code":"00409913711","type":"NDC"}],"standard_charges":[{"gross_charge":98.13,"discounted_cash":34.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409930130","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"00409930130","type":"NDC"}],"standard_charges":[{"gross_charge":94.32,"discounted_cash":33.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DARIFENACIN HYDROBROMIDE TAB ER 24HR 7.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00430017015","type":"CDM"},{"code":"00430017015","type":"NDC"}],"standard_charges":[{"gross_charge":17.6,"discounted_cash":6.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RISEDRONATE SODIUM TAB 35 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00430047207","type":"CDM"},{"code":"00430047207","type":"NDC"}],"standard_charges":[{"gross_charge":117.2,"discounted_cash":41.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MESALAMINE CAP DR 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00430075327","type":"CDM"},{"code":"00430075327","type":"NDC"}],"standard_charges":[{"gross_charge":4.16,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"THYROID TAB 60 MG (1 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456045901","type":"CDM"},{"code":"00456045901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VILAZODONE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456112030","type":"CDM"},{"code":"00456112030","type":"NDC"}],"standard_charges":[{"gross_charge":16.71,"discounted_cash":5.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NEBIVOLOL HCL TAB 2.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456140211","type":"CDM"},{"code":"00456140211","type":"NDC"}],"standard_charges":[{"gross_charge":7.45,"discounted_cash":2.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NEBIVOLOL HCL TAB 2.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456140230","type":"CDM"},{"code":"00456140230","type":"NDC"}],"standard_charges":[{"gross_charge":8.8,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456201001","type":"CDM"},{"code":"00456201001","type":"NDC"}],"standard_charges":[{"gross_charge":21.14,"discounted_cash":7.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00456270001","type":"CDM"},{"code":"J0714","type":"HCPCS"},{"code":"00456270001","type":"NDC"}],"standard_charges":[{"gross_charge":4050.9,"discounted_cash":1417.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DINOPROSTONE VAGINAL INSERTS 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456412363","type":"CDM"},{"code":"00456412363","type":"NDC"}],"standard_charges":[{"gross_charge":429.67,"discounted_cash":150.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FOSFOMYCIN TROMETHAMINE POWD PACK 3 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456430001","type":"CDM"},{"code":"00456430001","type":"NDC"}],"standard_charges":[{"gross_charge":97.39,"discounted_cash":34.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ADENOSINE IV SOLN 3 MG/ML (DIAGNOSTIC)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00469087120","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"00469087120","type":"NDC"}],"standard_charges":[{"gross_charge":2283.0,"discounted_cash":799.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ADENOSINE IV SOLN 3 MG/ML (DIAGNOSTIC)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00469087130","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"00469087130","type":"NDC"}],"standard_charges":[{"gross_charge":3424.17,"discounted_cash":1198.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00469321199","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"00469321199","type":"NDC"}],"standard_charges":[{"gross_charge":677.48,"discounted_cash":237.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00469325010","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"00469325010","type":"NDC"}],"standard_charges":[{"gross_charge":960.17,"discounted_cash":336.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NYSTATIN OINT 100000 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00472016630","type":"CDM"},{"code":"00472016630","type":"NDC"}],"standard_charges":[{"gross_charge":29.29,"discounted_cash":10.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PERMETHRIN CREAM 5%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx00472024260","type":"CDM"},{"code":"00472024260","type":"NDC"}],"standard_charges":[{"gross_charge":136.08,"discounted_cash":47.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYPROHEPTADINE HCL SYRUP 2 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00472140016","type":"CDM"},{"code":"00472140016","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LUBIPROSTONE CAP 24 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00480413806","type":"CDM"},{"code":"00480413806","type":"NDC"}],"standard_charges":[{"gross_charge":2.37,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POTASSIUM PHOSPHATE MONOBASIC TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00486111101","type":"CDM"},{"code":"00486111101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00487950100","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"00487950100","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00487970130","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00487970130","type":"NDC"}],"standard_charges":[{"gross_charge":3.39,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 1.25 MG/3ML (BASE EQUIV)","drug_information":{"unit":4.8,"type":"ML"},"code_information":[{"code":"Rx00487990401","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"00487990401","type":"NDC"}],"standard_charges":[{"gross_charge":2.96,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 1.25 MG/3ML (BASE EQUIV)","drug_information":{"unit":4.8,"type":"ML"},"code_information":[{"code":"Rx00487990425","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"00487990425","type":"NDC"}],"standard_charges":[{"gross_charge":2.92,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCORTISONE ACETATE W/ PRAMOXINE PERIANAL CREAM 1-1%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00496077804","type":"CDM"},{"code":"00496077804","type":"NDC"}],"standard_charges":[{"gross_charge":177.07,"discounted_cash":61.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXPANTHENOL INJ 250 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00517013125","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"00517013125","type":"NDC"}],"standard_charges":[{"gross_charge":96.26,"discounted_cash":33.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517074001","type":"CDM"},{"code":"J2210","type":"HCPCS"},{"code":"00517074001","type":"NDC"}],"standard_charges":[{"gross_charge":96.84,"discounted_cash":33.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OLANZAPINE FOR IM INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00517095501","type":"CDM"},{"code":"J2359","type":"HCPCS"},{"code":"00517095501","type":"NDC"}],"standard_charges":[{"gross_charge":405.32,"discounted_cash":141.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00517100125","type":"CDM"},{"code":"J0462","type":"HCPCS"},{"code":"00517100125","type":"NDC"}],"standard_charges":[{"gross_charge":95.93,"discounted_cash":33.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00517102025","type":"CDM"},{"code":"J2599","type":"HCPCS"},{"code":"00517102025","type":"NDC"}],"standard_charges":[{"gross_charge":95.54,"discounted_cash":33.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517271025","type":"CDM"},{"code":"00517271025","type":"NDC"}],"standard_charges":[{"gross_charge":193.98,"discounted_cash":67.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PAPAVERINE HCL INJ 30 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00517400225","type":"CDM"},{"code":"J2440","type":"HCPCS"},{"code":"00517400225","type":"NDC"}],"standard_charges":[{"gross_charge":170.66,"discounted_cash":59.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROXYZINE HCL IM SOLN 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517420125","type":"CDM"},{"code":"J3410","type":"HCPCS"},{"code":"00517420125","type":"NDC"}],"standard_charges":[{"gross_charge":188.44,"discounted_cash":65.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00517460125","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"00517460125","type":"NDC"}],"standard_charges":[{"gross_charge":94.31,"discounted_cash":33.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROXYZINE HCL IM SOLN 50 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00517560125","type":"CDM"},{"code":"J3410","type":"HCPCS"},{"code":"00517560125","type":"NDC"}],"standard_charges":[{"gross_charge":114.86,"discounted_cash":40.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 10%","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00517750425","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"00517750425","type":"NDC"}],"standard_charges":[{"gross_charge":7.84,"discounted_cash":2.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 20%","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00517760425","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"00517760425","type":"NDC"}],"standard_charges":[{"gross_charge":7.56,"discounted_cash":2.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ZINC SULFATE INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00517810525","type":"CDM"},{"code":"00517810525","type":"NDC"}],"standard_charges":[{"gross_charge":417.14,"discounted_cash":146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TRACE MIN (CR-CU-MN-ZN) INJ 1-100-25-1000 MCG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00517920325","type":"CDM"},{"code":"00517920325","type":"NDC"}],"standard_charges":[{"gross_charge":103.16,"discounted_cash":36.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DROPERIDOL INJ 2.5 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00517970225","type":"CDM"},{"code":"J1790","type":"HCPCS"},{"code":"00517970225","type":"NDC"}],"standard_charges":[{"gross_charge":100.51,"discounted_cash":35.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PILOCARPINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527131301","type":"CDM"},{"code":"00527131301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TERBUTALINE SULFATE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527131801","type":"CDM"},{"code":"00527131801","type":"NDC"}],"standard_charges":[{"gross_charge":6.07,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIGOXIN TAB 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527132401","type":"CDM"},{"code":"00527132401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXYCYCLINE MONOHYDRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527133850","type":"CDM"},{"code":"00527133850","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527134101","type":"CDM"},{"code":"00527134101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527169501","type":"CDM"},{"code":"00527169501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOFLOXACIN ORAL SOLN 25 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00527194866","type":"CDM"},{"code":"00527194866","type":"NDC"}],"standard_charges":[{"gross_charge":26.25,"discounted_cash":9.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00527512570","type":"CDM"},{"code":"00527512570","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00548902100","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"00548902100","type":"NDC"}],"standard_charges":[{"gross_charge":94.27,"discounted_cash":32.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ISONIAZID TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555006602","type":"CDM"},{"code":"00555006602","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MEPERIDINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555038102","type":"CDM"},{"code":"00555038102","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ESTRADIOL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555088602","type":"CDM"},{"code":"00555088602","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUDROCORTISONE ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555099702","type":"CDM"},{"code":"00555099702","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DEFEROXAMINE MESYLATE FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555113111","type":"CDM"},{"code":"J0895","type":"HCPCS"},{"code":"00555113111","type":"NDC"}],"standard_charges":[{"gross_charge":315.48,"discounted_cash":110.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NORETHINDRONE ACE & ETHINYL ESTRADIOL TAB 1.5 MG-30 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555902742","type":"CDM"},{"code":"00555902742","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NORETHINDRONE ACE & ETHINYL ESTRADIOL-FE TAB 1.5 MG-30 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555902858","type":"CDM"},{"code":"00555902858","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN PALMITATE HCL FOR SOLN 75 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00574012901","type":"CDM"},{"code":"00574012901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574022201","type":"CDM"},{"code":"00574022201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"REPAGLINIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574024101","type":"CDM"},{"code":"00574024101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00574080530","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"00574080530","type":"NDC"}],"standard_charges":[{"gross_charge":394.12,"discounted_cash":137.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TESTOSTERONE CYPIONATE IM INJ IN OIL 200 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00574082001","type":"CDM"},{"code":"J1071","type":"HCPCS"},{"code":"00574082001","type":"NDC"}],"standard_charges":[{"gross_charge":152.1,"discounted_cash":53.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ESTRADIOL VALERATE IM IN OIL 20 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00574087005","type":"CDM"},{"code":"J1380","type":"HCPCS"},{"code":"00574087005","type":"NDC"}],"standard_charges":[{"gross_charge":101.97,"discounted_cash":35.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00574200815","type":"CDM"},{"code":"00574200815","type":"NDC"}],"standard_charges":[{"gross_charge":21.64,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROCORTISONE ACETATE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574709012","type":"CDM"},{"code":"00574709012","type":"NDC"}],"standard_charges":[{"gross_charge":16.09,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591024001","type":"CDM"},{"code":"00591024001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TRIAMTERENE & HYDROCHLOROTHIAZIDE TAB 37.5-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591042401","type":"CDM"},{"code":"00591042401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ESTRADIOL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591048701","type":"CDM"},{"code":"00591048701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GLIPIZIDE TAB ER 24HR 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591084501","type":"CDM"},{"code":"00591084501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLIPIZIDE TAB ER 24HR 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591090030","type":"CDM"},{"code":"00591090030","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BRINZOLAMIDE OPHTH SUSP 1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00591212779","type":"CDM"},{"code":"00591212779","type":"NDC"}],"standard_charges":[{"gross_charge":407.86,"discounted_cash":142.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591222254","type":"CDM"},{"code":"J7515","type":"HCPCS"},{"code":"00591222254","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591267911","type":"CDM"},{"code":"00591267911","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":3.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.31 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00591291823","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"00591291823","type":"NDC"}],"standard_charges":[{"gross_charge":22.21,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TESTOSTERONE TD GEL 40.5 MG/2.5GM (1.62%)","drug_information":{"unit":2.5,"type":"GM"},"code_information":[{"code":"Rx00591292630","type":"CDM"},{"code":"00591292630","type":"NDC"}],"standard_charges":[{"gross_charge":5.17,"discounted_cash":1.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00591301230","type":"CDM"},{"code":"00591301230","type":"NDC"}],"standard_charges":[{"gross_charge":14.31,"discounted_cash":5.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591354060","type":"CDM"},{"code":"00591354060","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591360054","type":"CDM"},{"code":"00591360054","type":"NDC"}],"standard_charges":[{"gross_charge":4.1,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591360154","type":"CDM"},{"code":"00591360154","type":"NDC"}],"standard_charges":[{"gross_charge":7.45,"discounted_cash":2.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591360354","type":"CDM"},{"code":"00591360354","type":"NDC"}],"standard_charges":[{"gross_charge":15.06,"discounted_cash":5.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591371319","type":"CDM"},{"code":"00591371319","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DISOPYRAMIDE PHOSPHATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591556001","type":"CDM"},{"code":"00591556001","type":"NDC"}],"standard_charges":[{"gross_charge":2.79,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MINOCYCLINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591569550","type":"CDM"},{"code":"00591569550","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591588201","type":"CDM"},{"code":"00591588201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TELMISARTAN TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597003937","type":"CDM"},{"code":"00597003937","type":"NDC"}],"standard_charges":[{"gross_charge":6.44,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TELMISARTAN-HYDROCHLOROTHIAZIDE TAB 80-12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597004437","type":"CDM"},{"code":"00597004437","type":"NDC"}],"standard_charges":[{"gross_charge":6.44,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NEVIRAPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597004660","type":"CDM"},{"code":"00597004660","type":"NDC"}],"standard_charges":[{"gross_charge":20.93,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TIOTROPIUM BROMIDE INHAL AEROSOL 2.5 MCG/ACT","drug_information":{"unit":4.0,"type":"GM"},"code_information":[{"code":"Rx00597010051","type":"CDM"},{"code":"00597010051","type":"NDC"}],"standard_charges":[{"gross_charge":34.38,"discounted_cash":12.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00603148149","type":"CDM"},{"code":"00603148149","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00603154258","type":"CDM"},{"code":"00603154258","type":"NDC"}],"standard_charges":[{"gross_charge":4.02,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603155416","type":"CDM"},{"code":"00603155416","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":3.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROMETHAZINE-DM SYRUP 6.25-15 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00603158654","type":"CDM"},{"code":"00603158654","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROMETHAZINE-DM SYRUP 6.25-15 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00603158658","type":"CDM"},{"code":"00603158658","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603211521","type":"CDM"},{"code":"00603211521","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603254428","type":"CDM"},{"code":"00603254428","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603363302","type":"CDM"},{"code":"00603363302","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603363316","type":"CDM"},{"code":"00603363316","type":"NDC"}],"standard_charges":[{"gross_charge":1.93,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROCORTISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603389919","type":"CDM"},{"code":"00603389919","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603421021","type":"CDM"},{"code":"00603421021","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 4 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603465302","type":"CDM"},{"code":"00603465302","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603465416","type":"CDM"},{"code":"00603465416","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHENOBARBITAL TAB 32.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603516621","type":"CDM"},{"code":"00603516621","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROPAFENONE HCL TAB 225 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603544921","type":"CDM"},{"code":"00603544921","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 400-80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603578021","type":"CDM"},{"code":"00603578021","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TORSEMIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603613521","type":"CDM"},{"code":"00603613521","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NYSTATIN CREAM 100000 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00603781878","type":"CDM"},{"code":"00603781878","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":10.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00603786274","type":"CDM"},{"code":"00603786274","type":"NDC"}],"standard_charges":[{"gross_charge":4.65,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL INJ 50 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641037621","type":"CDM"},{"code":"J1200","type":"HCPCS"},{"code":"00641037621","type":"NDC"}],"standard_charges":[{"gross_charge":93.85,"discounted_cash":32.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 65 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641047621","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"00641047621","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 130 MG/ML","drug_information":{"unit":0.3846153846153846154,"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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PROMETHAZINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641094831","type":"CDM"},{"code":"J2550","type":"HCPCS"},{"code":"00641094831","type":"NDC"}],"standard_charges":[{"gross_charge":93.91,"discounted_cash":32.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641600701","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00641600701","type":"NDC"}],"standard_charges":[{"gross_charge":93.62,"discounted_cash":32.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641601301","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00641601301","type":"NDC"}],"standard_charges":[{"gross_charge":93.81,"discounted_cash":32.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 50 MG/10ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641601410","type":"CDM"},{"code":"00641601410","type":"NDC"}],"standard_charges":[{"gross_charge":93.95,"discounted_cash":32.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DOXAPRAM HCL INJ 20 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00641601801","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00641601801","type":"NDC"}],"standard_charges":[{"gross_charge":544.09,"discounted_cash":190.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXAPRAM HCL INJ 20 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00641601806","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00641601806","type":"NDC"}],"standard_charges":[{"gross_charge":523.04,"discounted_cash":183.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641601901","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00641601901","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641602201","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"00641602201","type":"NDC"}],"standard_charges":[{"gross_charge":93.6,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641602225","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"00641602225","type":"NDC"}],"standard_charges":[{"gross_charge":93.5,"discounted_cash":32.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641602725","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00641602725","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 2500 MCG/50ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641603001","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00641603001","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641604801","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641604801","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641605001","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641605001","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641605010","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641605010","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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":"Rx00641605725","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641605725","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ONDANSETRON HCL INJ 40 MG/20ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641607901","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"00641607901","type":"NDC"}],"standard_charges":[{"gross_charge":93.45,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROMETHAZINE HCL INJ 25 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641608201","type":"CDM"},{"code":"J2550","type":"HCPCS"},{"code":"00641608201","type":"NDC"}],"standard_charges":[{"gross_charge":93.99,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROMETHAZINE HCL INJ 25 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641608225","type":"CDM"},{"code":"J2550","type":"HCPCS"},{"code":"00641608225","type":"NDC"}],"standard_charges":[{"gross_charge":93.98,"discounted_cash":32.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00641611601","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00641611601","type":"NDC"}],"standard_charges":[{"gross_charge":96.68,"discounted_cash":33.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00641611901","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00641611901","type":"NDC"}],"standard_charges":[{"gross_charge":96.51,"discounted_cash":33.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00641611910","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00641611910","type":"NDC"}],"standard_charges":[{"gross_charge":96.51,"discounted_cash":33.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00641612001","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00641612001","type":"NDC"}],"standard_charges":[{"gross_charge":99.18,"discounted_cash":34.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00641612525","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00641612525","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641612725","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00641612725","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","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: JVCPCT LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641613710","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"00641613710","type":"NDC"}],"standard_charges":[{"gross_charge":95.45,"discounted_cash":33.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 2 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00641615101","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00641615101","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMIKACIN SULFATE INJ 500 MG/2ML (250 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641616710","type":"CDM"},{"code":"J0278","type":"HCPCS"},{"code":"00641616710","type":"NDC"}],"standard_charges":[{"gross_charge":97.12,"discounted_cash":33.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641619110","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00641619110","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00641619210","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00641619210","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00641620510","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"00641620510","type":"NDC"}],"standard_charges":[{"gross_charge":95.25,"discounted_cash":33.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00641623825","type":"CDM"},{"code":"00641623825","type":"NDC"}],"standard_charges":[{"gross_charge":93.61,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 0.5 MG/5ML (100 MCG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641624510","type":"CDM"},{"code":"J2373","type":"HCPCS"},{"code":"00641624510","type":"NDC"}],"standard_charges":[{"gross_charge":93.81,"discounted_cash":32.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00641625201","type":"CDM"},{"code":"J1921","type":"HCPCS"},{"code":"00641625201","type":"NDC"}],"standard_charges":[{"gross_charge":96.88,"discounted_cash":33.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 50 MG/10ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641921801","type":"CDM"},{"code":"00641921801","type":"NDC"}],"standard_charges":[{"gross_charge":93.67,"discounted_cash":32.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00703024101","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"00703024101","type":"NDC"}],"standard_charges":[{"gross_charge":96.96,"discounted_cash":33.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00703291403","type":"CDM"},{"code":"00703291403","type":"NDC"}],"standard_charges":[{"gross_charge":99.02,"discounted_cash":34.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 50 MG/2ML (25 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00703367103","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"00703367103","type":"NDC"}],"standard_charges":[{"gross_charge":262.07,"discounted_cash":91.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 150 MG/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00703424601","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"00703424601","type":"NDC"}],"standard_charges":[{"gross_charge":319.02,"discounted_cash":111.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 450 MG/45ML","drug_information":{"unit":45.0,"type":"ML"},"code_information":[{"code":"Rx00703424801","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"00703424801","type":"NDC"}],"standard_charges":[{"gross_charge":644.46,"discounted_cash":225.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VINCRISTINE SULFATE IV SOLN 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00703440211","type":"CDM"},{"code":"J9370","type":"HCPCS"},{"code":"00703440211","type":"NDC"}],"standard_charges":[{"gross_charge":281.45,"discounted_cash":98.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00703450204","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"00703450204","type":"NDC"}],"standard_charges":[{"gross_charge":93.98,"discounted_cash":32.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PACLITAXEL IV CONC 30 MG/5ML (6 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00703476401","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"00703476401","type":"NDC"}],"standard_charges":[{"gross_charge":242.58,"discounted_cash":84.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DACARBAZINE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00703507501","type":"CDM"},{"code":"J9130","type":"HCPCS"},{"code":"00703507501","type":"NDC"}],"standard_charges":[{"gross_charge":278.06,"discounted_cash":97.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00703514001","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"00703514001","type":"NDC"}],"standard_charges":[{"gross_charge":286.32,"discounted_cash":100.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CISPLATIN INJ 50 MG/50ML (1 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00703574711","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"00703574711","type":"NDC"}],"standard_charges":[{"gross_charge":272.41,"discounted_cash":95.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM IV SOLN 400-80 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00703950303","type":"CDM"},{"code":"J2865","type":"HCPCS"},{"code":"00703950303","type":"NDC"}],"standard_charges":[{"gross_charge":98.92,"discounted_cash":34.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUOCINOLONE ACETONIDE CREAM 0.025%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00713022215","type":"CDM"},{"code":"00713022215","type":"NDC"}],"standard_charges":[{"gross_charge":37.55,"discounted_cash":13.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE OINT 0.025%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00713022915","type":"CDM"},{"code":"00713022915","type":"NDC"}],"standard_charges":[{"gross_charge":4.29,"discounted_cash":1.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUOCINOLONE ACETONIDE CREAM 0.025%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00713032415","type":"CDM"},{"code":"00713032415","type":"NDC"}],"standard_charges":[{"gross_charge":48.42,"discounted_cash":16.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE DENTAL PASTE 0.1%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00713065540","type":"CDM"},{"code":"00713065540","type":"NDC"}],"standard_charges":[{"gross_charge":89.94,"discounted_cash":31.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NYSTATIN OINT 100000 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00713068631","type":"CDM"},{"code":"00713068631","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":5.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PERPHENAZINE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781104613","type":"CDM"},{"code":"00781104613","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781106101","type":"CDM"},{"code":"00781106101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781107701","type":"CDM"},{"code":"00781107701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLIPIZIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781145301","type":"CDM"},{"code":"00781145301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781148601","type":"CDM"},{"code":"00781148601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781155601","type":"CDM"},{"code":"00781155601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781155613","type":"CDM"},{"code":"00781155613","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DICLOFENAC SODIUM TAB DELAYED RELEASE 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781178501","type":"CDM"},{"code":"00781178501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DESIPRAMINE HCL TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781197401","type":"CDM"},{"code":"00781197401","type":"NDC"}],"standard_charges":[{"gross_charge":4.87,"discounted_cash":1.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CLOMIPRAMINE HCL CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781203701","type":"CDM"},{"code":"00781203701","type":"NDC"}],"standard_charges":[{"gross_charge":9.34,"discounted_cash":3.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEFDINIR CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781217660","type":"CDM"},{"code":"00781217660","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DICLOXACILLIN SODIUM CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781224801","type":"CDM"},{"code":"00781224801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781261301","type":"CDM"},{"code":"00781261301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RIVASTIGMINE TARTRATE CAP 1.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781261460","type":"CDM"},{"code":"00781261460","type":"NDC"}],"standard_charges":[{"gross_charge":4.76,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RIVASTIGMINE TARTRATE CAP 3 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781261513","type":"CDM"},{"code":"00781261513","type":"NDC"}],"standard_charges":[{"gross_charge":3.82,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OXACILLIN SODIUM FOR INJ 2 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781310180","type":"CDM"},{"code":"J2700","type":"HCPCS"},{"code":"00781310180","type":"NDC"}],"standard_charges":[{"gross_charge":269.69,"discounted_cash":94.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00781311390","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781311390","type":"NDC"}],"standard_charges":[{"gross_charge":96.42,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781317780","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00781317780","type":"NDC"}],"standard_charges":[{"gross_charge":117.18,"discounted_cash":41.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781317796","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00781317796","type":"NDC"}],"standard_charges":[{"gross_charge":96.52,"discounted_cash":33.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FOMEPIZOLE INJ 1 GM/ML (FOR IV INFUSION)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00781318273","type":"CDM"},{"code":"J1451","type":"HCPCS"},{"code":"00781318273","type":"NDC"}],"standard_charges":[{"gross_charge":11223.4,"discounted_cash":3928.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00781320470","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"00781320470","type":"NDC"}],"standard_charges":[{"gross_charge":258.38,"discounted_cash":90.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781320695","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781320695","type":"NDC"}],"standard_charges":[{"gross_charge":93.95,"discounted_cash":32.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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":"Rx00781322095","type":"CDM"},{"code":"00781322095","type":"NDC"}],"standard_charges":[{"gross_charge":94.68,"discounted_cash":33.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00781322402","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781322402","type":"NDC"}],"standard_charges":[{"gross_charge":183.55,"discounted_cash":64.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781323394","type":"CDM"},{"code":"J9075","type":"HCPCS"},{"code":"00781323394","type":"NDC"}],"standard_charges":[{"gross_charge":548.36,"discounted_cash":191.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AZACITIDINE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781325394","type":"CDM"},{"code":"J9025","type":"HCPCS"},{"code":"00781325394","type":"NDC"}],"standard_charges":[{"gross_charge":6100.44,"discounted_cash":2135.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00781326995","type":"CDM"},{"code":"00781326995","type":"NDC"}],"standard_charges":[{"gross_charge":93.65,"discounted_cash":32.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 300 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781328809","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781328809","type":"NDC"}],"standard_charges":[{"gross_charge":245.8,"discounted_cash":86.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781328991","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781328991","type":"NDC"}],"standard_charges":[{"gross_charge":248.3,"discounted_cash":86.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML,LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML,LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00781334209","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00781334209","type":"NDC"}],"standard_charges":[{"gross_charge":245.4,"discounted_cash":85.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML,LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML,LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00781334246","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00781334246","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340278","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340278","type":"NDC"}],"standard_charges":[{"gross_charge":93.82,"discounted_cash":32.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340895","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340895","type":"NDC"}],"standard_charges":[{"gross_charge":95.61,"discounted_cash":33.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00781341195","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"00781341195","type":"NDC"}],"standard_charges":[{"gross_charge":94.6,"discounted_cash":33.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781345095","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00781345095","type":"NDC"}],"standard_charges":[{"gross_charge":94.98,"discounted_cash":33.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TIGECYCLINE FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781348192","type":"CDM"},{"code":"J3243","type":"HCPCS"},{"code":"00781348192","type":"NDC"}],"standard_charges":[{"gross_charge":142.6,"discounted_cash":49.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00781354325","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00781354325","type":"NDC"}],"standard_charges":[{"gross_charge":93.39,"discounted_cash":32.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 88 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781518392","type":"CDM"},{"code":"00781518392","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDE TAB 100-12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781520431","type":"CDM"},{"code":"00781520431","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDE TAB 100-12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781520492","type":"CDM"},{"code":"00781520492","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDE TAB 50-12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781520692","type":"CDM"},{"code":"00781520692","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781523806","type":"CDM"},{"code":"00781523806","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781531008","type":"CDM"},{"code":"00781531008","type":"NDC"}],"standard_charges":[{"gross_charge":4.51,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781540192","type":"CDM"},{"code":"00781540192","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 4 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781555431","type":"CDM"},{"code":"00781555431","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781556092","type":"CDM"},{"code":"00781556092","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VALSARTAN TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781561892","type":"CDM"},{"code":"00781561892","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781574801","type":"CDM"},{"code":"00781574801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781577631","type":"CDM"},{"code":"00781577631","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARBAMAZEPINE TAB ER 12HR 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781598701","type":"CDM"},{"code":"00781598701","type":"NDC"}],"standard_charges":[{"gross_charge":2.28,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLARITHROMYCIN FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781602352","type":"CDM"},{"code":"00781602352","type":"NDC"}],"standard_charges":[{"gross_charge":10.97,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781604146","type":"CDM"},{"code":"00781604146","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781604158","type":"CDM"},{"code":"00781604158","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 600-42.9 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781613957","type":"CDM"},{"code":"00781613957","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 200 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781615652","type":"CDM"},{"code":"00781615652","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 400 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781615757","type":"CDM"},{"code":"00781615757","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METRONIDAZOLE GEL 0.75%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx00781707819","type":"CDM"},{"code":"00781707819","type":"NDC"}],"standard_charges":[{"gross_charge":14.78,"discounted_cash":5.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CALCIPOTRIENE CREAM 0.005%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx00781711735","type":"CDM"},{"code":"00781711735","type":"NDC"}],"standard_charges":[{"gross_charge":489.87,"discounted_cash":171.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.025 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781712983","type":"CDM"},{"code":"00781712983","type":"NDC"}],"standard_charges":[{"gross_charge":15.16,"discounted_cash":5.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.05 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781714483","type":"CDM"},{"code":"00781714483","type":"NDC"}],"standard_charges":[{"gross_charge":15.17,"discounted_cash":5.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.075 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781715683","type":"CDM"},{"code":"00781715683","type":"NDC"}],"standard_charges":[{"gross_charge":15.19,"discounted_cash":5.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781716783","type":"CDM"},{"code":"00781716783","type":"NDC"}],"standard_charges":[{"gross_charge":15.19,"discounted_cash":5.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"RIVASTIGMINE TD PATCH 24HR 9.5 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781730958","type":"CDM"},{"code":"00781730958","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":5.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781912585","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"00781912585","type":"NDC"}],"standard_charges":[{"gross_charge":137.45,"discounted_cash":48.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00781932470","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"00781932470","type":"NDC"}],"standard_charges":[{"gross_charge":225.23,"discounted_cash":78.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781932785","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781932785","type":"NDC"}],"standard_charges":[{"gross_charge":94.23,"discounted_cash":32.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781932795","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781932795","type":"NDC"}],"standard_charges":[{"gross_charge":95.91,"discounted_cash":33.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781932885","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781932885","type":"NDC"}],"standard_charges":[{"gross_charge":94.45,"discounted_cash":33.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781932895","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781932895","type":"NDC"}],"standard_charges":[{"gross_charge":97.59,"discounted_cash":34.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832003800","type":"CDM"},{"code":"00832003800","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832108000","type":"CDM"},{"code":"00832108000","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121501","type":"CDM"},{"code":"00832121501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMANTADINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832201200","type":"CDM"},{"code":"00832201200","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832601800","type":"CDM"},{"code":"00832601800","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832712211","type":"CDM"},{"code":"00832712211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904020261","type":"CDM"},{"code":"00904020261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904041161","type":"CDM"},{"code":"00904041161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIPYRIDAMOLE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904108661","type":"CDM"},{"code":"00904108661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SALSALATE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904125061","type":"CDM"},{"code":"00904125061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SALSALATE TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904125161","type":"CDM"},{"code":"00904125161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904215461","type":"CDM"},{"code":"00904215461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904282161","type":"CDM"},{"code":"00904282161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CAPTOPRIL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904504561","type":"CDM"},{"code":"00904504561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NAPROXEN TAB 375 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904559060","type":"CDM"},{"code":"00904559060","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NAPROXEN TAB 375 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904559061","type":"CDM"},{"code":"00904559061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904563261","type":"CDM"},{"code":"00904563261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904565661","type":"CDM"},{"code":"00904565661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904579661","type":"CDM"},{"code":"00904579661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904580961","type":"CDM"},{"code":"00904580961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LISINOPRIL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904581061","type":"CDM"},{"code":"00904581061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904581161","type":"CDM"},{"code":"00904581161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904585861","type":"CDM"},{"code":"00904585861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LABETALOL HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904592961","type":"CDM"},{"code":"00904592961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"RISPERIDONE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904597461","type":"CDM"},{"code":"00904597461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RISPERIDONE TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904597761","type":"CDM"},{"code":"00904597761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904598061","type":"CDM"},{"code":"00904598061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904599461","type":"CDM"},{"code":"00904599461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904601004","type":"CDM"},{"code":"00904601004","type":"NDC"}],"standard_charges":[{"gross_charge":2.56,"discounted_cash":0.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BICALUTAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904601946","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00904601946","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVETIRACETAM TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904605361","type":"CDM"},{"code":"00904605361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904607361","type":"CDM"},{"code":"00904607361","type":"NDC"}],"standard_charges":[{"gross_charge":4.21,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUPROPION HCL TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904609361","type":"CDM"},{"code":"00904609361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLONAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904610261","type":"CDM"},{"code":"00904610261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904612661","type":"CDM"},{"code":"00904612661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPROPION HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904612961","type":"CDM"},{"code":"00904612961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 100 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904617161","type":"CDM"},{"code":"00904617161","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904618761","type":"CDM"},{"code":"00904618761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904627761","type":"CDM"},{"code":"00904627761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904627861","type":"CDM"},{"code":"00904627861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904628061","type":"CDM"},{"code":"00904628061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OLANZAPINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904628561","type":"CDM"},{"code":"00904628561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904631461","type":"CDM"},{"code":"00904631461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METFORMIN HCL TAB 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904632861","type":"CDM"},{"code":"00904632861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904634061","type":"CDM"},{"code":"00904634061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904634161","type":"CDM"},{"code":"00904634161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904634761","type":"CDM"},{"code":"00904634761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904635961","type":"CDM"},{"code":"00904635961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RISPERIDONE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904636061","type":"CDM"},{"code":"00904636061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904639061","type":"CDM"},{"code":"00904639061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904640861","type":"CDM"},{"code":"00904640861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904641961","type":"CDM"},{"code":"00904641961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904644161","type":"CDM"},{"code":"00904644161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904644361","type":"CDM"},{"code":"00904644361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904644461","type":"CDM"},{"code":"00904644461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LISINOPRIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904648561","type":"CDM"},{"code":"00904648561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904656461","type":"CDM"},{"code":"00904656461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904664061","type":"CDM"},{"code":"00904664061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GABAPENTIN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904682361","type":"CDM"},{"code":"00904682361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CHLORTHALIDONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904690061","type":"CDM"},{"code":"00904690061","type":"NDC"}],"standard_charges":[{"gross_charge":2.61,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SERTRALINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904692561","type":"CDM"},{"code":"00904692561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SERTRALINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904692661","type":"CDM"},{"code":"00904692661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 150 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695661","type":"CDM"},{"code":"00904695661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 175 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695761","type":"CDM"},{"code":"00904695761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PREGABALIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904699104","type":"CDM"},{"code":"00904699104","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904701606","type":"CDM"},{"code":"00904701606","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METHOCARBAMOL TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904705861","type":"CDM"},{"code":"00904705861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904708404","type":"CDM"},{"code":"00904708404","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVETIRACETAM TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712361","type":"CDM"},{"code":"00904712361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DRONABINOL CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904714504","type":"CDM"},{"code":"00904714504","type":"NDC"}],"standard_charges":[{"gross_charge":23.64,"discounted_cash":8.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NEBIVOLOL HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904718904","type":"CDM"},{"code":"00904718904","type":"NDC"}],"standard_charges":[{"gross_charge":2.88,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904721761","type":"CDM"},{"code":"00904721761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904721961","type":"CDM"},{"code":"00904721961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904722761","type":"CDM"},{"code":"00904722761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904724361","type":"CDM"},{"code":"00904724361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXCARBAZEPINE TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904726461","type":"CDM"},{"code":"00904726461","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904726541","type":"CDM"},{"code":"00904726541","type":"NDC"}],"standard_charges":[{"gross_charge":4.11,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904726594","type":"CDM"},{"code":"00904726594","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904730561","type":"CDM"},{"code":"00904730561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARVEDILOL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904730761","type":"CDM"},{"code":"00904730761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARVEDILOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904730861","type":"CDM"},{"code":"00904730861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904733661","type":"CDM"},{"code":"00904733661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904749661","type":"CDM"},{"code":"00904749661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904750161","type":"CDM"},{"code":"00904750161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SODIUM CITRATE IV SOLN PREFILLED SYRINGE 4%,SODIUM CITRATE LOCK FLUSH IV SOLN PREF SYR 120 MG/3ML (4%),SODIUM CITRATE SOLN PREFILLED SYRINGE 4%,SODIUM CITRATE LOCK FLUSH IV SOLN 4%,ANTICOAGULANT SODIUM CITRATE SOLN 4%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00942950410","type":"CDM"},{"code":"00942950410","type":"NDC"}],"standard_charges":[{"gross_charge":93.28,"discounted_cash":32.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CITRATE IV SOLN PREFILLED SYRINGE 4%,SODIUM CITRATE LOCK FLUSH IV SOLN PREF SYR 120 MG/3ML (4%),SODIUM CITRATE SOLN PREFILLED SYRINGE 4%,SODIUM CITRATE LOCK FLUSH IV SOLN 4%,ANTICOAGULANT SODIUM CITRATE SOLN 4%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00942950510","type":"CDM"},{"code":"00942950510","type":"NDC"}],"standard_charges":[{"gross_charge":93.32,"discounted_cash":32.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00944049302","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"00944049302","type":"NDC"}],"standard_charges":[{"gross_charge":692.16,"discounted_cash":242.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00955100410","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00955100410","type":"NDC"}],"standard_charges":[{"gross_charge":101.19,"discounted_cash":35.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx00955101001","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00955101001","type":"NDC"}],"standard_charges":[{"gross_charge":199.66,"discounted_cash":69.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx00955101010","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00955101010","type":"NDC"}],"standard_charges":[{"gross_charge":200.32,"discounted_cash":70.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.7333333333333333333,"type":"ML"},"code_information":[{"code":"Rx00955101210","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00955101210","type":"NDC"}],"standard_charges":[{"gross_charge":244.79,"discounted_cash":85.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SEVELAMER CARBONATE PACKET 0.8 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00955105290","type":"CDM"},{"code":"00955105290","type":"NDC"}],"standard_charges":[{"gross_charge":13.19,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEFLUNOMIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00955173530","type":"CDM"},{"code":"00955173530","type":"NDC"}],"standard_charges":[{"gross_charge":6.92,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"},{"gross_charge":242.43,"discounted_cash":84.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00990790203","type":"CDM"},{"code":"00990790203","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00990790309","type":"CDM"},{"code":"00990790309","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00990790409","type":"CDM"},{"code":"00990790409","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L (0.15%) IN DEXTROSE 5% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00990790509","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00990790509","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00990796709","type":"CDM"},{"code":"00990796709","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx00990796709","type":"CDM"},{"code":"00990796709","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00990797207","type":"CDM"},{"code":"00990797207","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00990798361","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00990798361","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00998020315","type":"CDM"},{"code":"00998020315","type":"NDC"}],"standard_charges":[{"gross_charge":128.94,"discounted_cash":45.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 2%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00998020415","type":"CDM"},{"code":"00998020415","type":"NDC"}],"standard_charges":[{"gross_charge":131.89,"discounted_cash":46.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH SUSP 0.1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00998063006","type":"CDM"},{"code":"00998063006","type":"NDC"}],"standard_charges":[{"gross_charge":156.64,"discounted_cash":54.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 20%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx05170760401","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"05170760401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) LOCK FLUSH PF IV SOLN 10 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx08290306413","type":"CDM"},{"code":"J1642","type":"HCPCS"},{"code":"08290306413","type":"NDC"}],"standard_charges":[{"gross_charge":93.52,"discounted_cash":32.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SILVER - GEL","drug_information":{"unit":44.4,"type":"ML"},"code_information":[{"code":"Rx08327030909","type":"CDM"},{"code":"08327030909","type":"NDC"}],"standard_charges":[{"gross_charge":33.69,"discounted_cash":11.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019055303","type":"CDM"},{"code":"10019055303","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019055388","type":"CDM"},{"code":"10019055388","type":"NDC"}],"standard_charges":[{"gross_charge":29.88,"discounted_cash":10.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"IFOSFAMIDE FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019092582","type":"CDM"},{"code":"J9208","type":"HCPCS"},{"code":"10019092582","type":"NDC"}],"standard_charges":[{"gross_charge":408.91,"discounted_cash":143.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"IFOSFAMIDE FOR INJ 3 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019092616","type":"CDM"},{"code":"J9208","type":"HCPCS"},{"code":"10019092616","type":"NDC"}],"standard_charges":[{"gross_charge":914.59,"discounted_cash":320.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MESNA INJ 100 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx10019095301","type":"CDM"},{"code":"J9209","type":"HCPCS"},{"code":"10019095301","type":"NDC"}],"standard_charges":[{"gross_charge":366.99,"discounted_cash":128.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019095550","type":"CDM"},{"code":"J9075","type":"HCPCS"},{"code":"10019095550","type":"NDC"}],"standard_charges":[{"gross_charge":838.99,"discounted_cash":293.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GALANTAMINE HYDROBROMIDE CAP ER 24HR 8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10147089103","type":"CDM"},{"code":"10147089103","type":"NDC"}],"standard_charges":[{"gross_charge":7.05,"discounted_cash":2.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HALOPERIDOL DECANOATE IM SOLN 100 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx10147092205","type":"CDM"},{"code":"J1631","type":"HCPCS"},{"code":"10147092205","type":"NDC"}],"standard_charges":[{"gross_charge":253.44,"discounted_cash":88.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10370083211","type":"CDM"},{"code":"10370083211","type":"NDC"}],"standard_charges":[{"gross_charge":2.43,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MOMETASONE FUROATE SINUS IMPLANT 1350 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10599000301","type":"CDM"},{"code":"J7402","type":"HCPCS"},{"code":"10599000301","type":"NDC"}],"standard_charges":[{"gross_charge":2058.52,"discounted_cash":720.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCORTISONE PERIANAL CREAM 2.5%","drug_information":{"unit":28.35,"type":"GM"},"code_information":[{"code":"Rx10631040701","type":"CDM"},{"code":"10631040701","type":"NDC"}],"standard_charges":[{"gross_charge":97.63,"discounted_cash":34.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PARICALCITOL CAP 1 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10888500102","type":"CDM"},{"code":"10888500102","type":"NDC"}],"standard_charges":[{"gross_charge":5.84,"discounted_cash":2.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL-CLIDINIUM BROMIDE CAP 5-2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx11534019701","type":"CDM"},{"code":"11534019701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SULFACETAMIDE SODIUM OPHTH SOLN 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx11980001105","type":"CDM"},{"code":"11980001105","type":"NDC"}],"standard_charges":[{"gross_charge":177.42,"discounted_cash":62.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SULFACETAMIDE SODIUM-PREDNISOLONE OPHTH SUSP 10-0.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx11980002205","type":"CDM"},{"code":"11980002205","type":"NDC"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":78.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PREDNISOLONE ACETATE OPHTH SUSP 1%","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx11980018005","type":"CDM"},{"code":"11980018005","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ALPHA1-PROTEINASE INHIBITOR (HUMAN) INJ 1000 MG/20ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13533070501","type":"CDM"},{"code":"J0256","type":"HCPCS"},{"code":"13533070501","type":"NDC"}],"standard_charges":[{"gross_charge":5376.0,"discounted_cash":1881.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 5 GM/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx13533080020","type":"CDM"},{"code":"J1561","type":"HCPCS"},{"code":"13533080020","type":"NDC"}],"standard_charges":[{"gross_charge":3645.04,"discounted_cash":1275.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CITALOPRAM HYDROBROMIDE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668001001","type":"CDM"},{"code":"13668001001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668009490","type":"CDM"},{"code":"13668009490","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668018930","type":"CDM"},{"code":"13668018930","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"APREPITANT CAPSULE 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668059181","type":"CDM"},{"code":"J8501","type":"HCPCS"},{"code":"13668059181","type":"NDC"}],"standard_charges":[{"gross_charge":69.43,"discounted_cash":24.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"B-COMPLEX W/ C & FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13811051510","type":"CDM"},{"code":"13811051510","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13811068130","type":"CDM"},{"code":"13811068130","type":"NDC"}],"standard_charges":[{"gross_charge":11.67,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13811071910","type":"CDM"},{"code":"13811071910","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx14789001101","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"14789001101","type":"NDC"}],"standard_charges":[{"gross_charge":1085.91,"discounted_cash":380.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FLUORESCEIN SODIUM IV SOLN 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx14789012205","type":"CDM"},{"code":"A9612","type":"HCPCS"},{"code":"14789012205","type":"NDC"}],"standard_charges":[{"gross_charge":547.84,"discounted_cash":191.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EPHEDRINE SULF-NACL SOLN PREF SYR 25 MG/5ML-0.9% (5 MG/ML),EPHEDRINE SULFATE PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),EPHEDRINE SULF-NACL SOLN PREF SYR 50 MG/10ML-0.9% (5 MG/ML),EPHEDRINE SULFATE PREFILLED SYRINGE 10 MG/2ML (5 MG/ML),EPHEDRINE SULFATE INJ SOLN PREF SYRINGE 25 MG/5ML (5 MG/ML),EPHEDRINE SULFATE INJ SOLN PREF SYRINGE 50 MG/10ML (5 MG/ML),EPHEDRINE SULFATE IV SOLN 5 MG/ML,EPHEDRINE SULFATE PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),EPHEDRINE SULF-NACL SOLN PREF SYR 15 MG/3ML-0.9% (5 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx14789025010","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"14789025010","type":"NDC"}],"standard_charges":[{"gross_charge":241.39,"discounted_cash":84.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROCAINAMIDE HCL INJ 500 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx14789090002","type":"CDM"},{"code":"J2690","type":"HCPCS"},{"code":"14789090002","type":"NDC"}],"standard_charges":[{"gross_charge":5853.5,"discounted_cash":2048.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ISRADIPINE CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16252053901","type":"CDM"},{"code":"16252053901","type":"NDC"}],"standard_charges":[{"gross_charge":2.07,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ISRADIPINE CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16252054001","type":"CDM"},{"code":"16252054001","type":"NDC"}],"standard_charges":[{"gross_charge":3.14,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16252059099","type":"CDM"},{"code":"16252059099","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16252061730","type":"CDM"},{"code":"16252061730","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PREDNISOLONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16477050501","type":"CDM"},{"code":"16477050501","type":"NDC"}],"standard_charges":[{"gross_charge":10.14,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CIPROFLOXACIN HCL OPHTH SOLN 0.3% (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx16571012025","type":"CDM"},{"code":"16571012025","type":"NDC"}],"standard_charges":[{"gross_charge":12.42,"discounted_cash":4.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx16571014050","type":"CDM"},{"code":"16571014050","type":"NDC"}],"standard_charges":[{"gross_charge":2.38,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571016501","type":"CDM"},{"code":"16571016501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571016601","type":"CDM"},{"code":"16571016601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DICLOFENAC SODIUM TAB DELAYED RELEASE 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571020310","type":"CDM"},{"code":"16571020310","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEVIMELINE HCL CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571065710","type":"CDM"},{"code":"16571065710","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHENOBARBITAL ELIXIR 20 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx16571067516","type":"CDM"},{"code":"16571067516","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCORTISONE ACETATE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571067621","type":"CDM"},{"code":"16571067621","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLOMIPRAMINE HCL CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571068403","type":"CDM"},{"code":"16571068403","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PROPAFENONE HCL CAP ER 12HR 225 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571073606","type":"CDM"},{"code":"16571073606","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOCARNITINE TAB 330 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571076209","type":"CDM"},{"code":"16571076209","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571081320","type":"CDM"},{"code":"16571081320","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571088310","type":"CDM"},{"code":"16571088310","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEFLUNOMIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16714032101","type":"CDM"},{"code":"16714032101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SIMVASTATIN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729000415","type":"CDM"},{"code":"16729000415","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729001901","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"16729001901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 15 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729002010","type":"CDM"},{"code":"16729002010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LETROZOLE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729003410","type":"CDM"},{"code":"16729003410","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ANASTROZOLE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729003510","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"16729003510","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TACROLIMUS CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729004101","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"16729004101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CAPECITABINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729007329","type":"CDM"},{"code":"J8522","type":"HCPCS"},{"code":"16729007329","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729009416","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"16729009416","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729021301","type":"CDM"},{"code":"16729021301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DECITABINE FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729022405","type":"CDM"},{"code":"J0894","type":"HCPCS"},{"code":"16729022405","type":"NDC"}],"standard_charges":[{"gross_charge":616.83,"discounted_cash":215.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx16729023993","type":"CDM"},{"code":"16729023993","type":"NDC"}],"standard_charges":[{"gross_charge":95.14,"discounted_cash":33.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx16729026763","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"16729026763","type":"NDC"}],"standard_charges":[{"gross_charge":387.67,"discounted_cash":135.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 2.5 GM/50ML (50 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx16729027611","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"16729027611","type":"NDC"}],"standard_charges":[{"gross_charge":415.36,"discounted_cash":145.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 250 MG/10ML (25 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx16729027703","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"16729027703","type":"NDC"}],"standard_charges":[{"gross_charge":289.23,"discounted_cash":101.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 1000 MG/40ML (25 MG/ML)","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx16729027735","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"16729027735","type":"NDC"}],"standard_charges":[{"gross_charge":322.7,"discounted_cash":112.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 50 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx16729029531","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"16729029531","type":"NDC"}],"standard_charges":[{"gross_charge":264.05,"discounted_cash":92.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 150 MG/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx16729029533","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"16729029533","type":"NDC"}],"standard_charges":[{"gross_charge":304.78,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 450 MG/45ML","drug_information":{"unit":45.0,"type":"ML"},"code_information":[{"code":"Rx16729029534","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"16729029534","type":"NDC"}],"standard_charges":[{"gross_charge":441.57,"discounted_cash":154.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ONDANSETRON HCL INJ 40 MG/20ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx16729029805","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"16729029805","type":"NDC"}],"standard_charges":[{"gross_charge":93.75,"discounted_cash":32.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AZACITIDINE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729030610","type":"CDM"},{"code":"J9025","type":"HCPCS"},{"code":"16729030610","type":"NDC"}],"standard_charges":[{"gross_charge":451.06,"discounted_cash":157.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 50 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx16729033203","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"16729033203","type":"NDC"}],"standard_charges":[{"gross_charge":288.27,"discounted_cash":100.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 100 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx16729033205","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"16729033205","type":"NDC"}],"standard_charges":[{"gross_charge":232.3,"discounted_cash":81.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TIGECYCLINE FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729036468","type":"CDM"},{"code":"J3244","type":"HCPCS"},{"code":"16729036468","type":"NDC"}],"standard_charges":[{"gross_charge":328.12,"discounted_cash":114.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729043505","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"16729043505","type":"NDC"}],"standard_charges":[{"gross_charge":325.13,"discounted_cash":113.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx16729048445","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"16729048445","type":"NDC"}],"standard_charges":[{"gross_charge":97.07,"discounted_cash":33.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx16729052608","type":"CDM"},{"code":"J0462","type":"HCPCS"},{"code":"16729052608","type":"NDC"}],"standard_charges":[{"gross_charge":97.51,"discounted_cash":34.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUORESCEIN W/ BENOXINATE OPHTH SOLN 0.25-0.4%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17238050105","type":"CDM"},{"code":"17238050105","type":"NDC"}],"standard_charges":[{"gross_charge":9.21,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx17271070106","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"17271070106","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478008130","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"17478008130","type":"NDC"}],"standard_charges":[{"gross_charge":94.17,"discounted_cash":32.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 2%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478009702","type":"CDM"},{"code":"17478009702","type":"NDC"}],"standard_charges":[{"gross_charge":32.49,"discounted_cash":11.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TROPICAMIDE OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx17478010212","type":"CDM"},{"code":"17478010212","type":"NDC"}],"standard_charges":[{"gross_charge":11.7,"discounted_cash":4.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE OPHTH SOLN 0.4%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478020810","type":"CDM"},{"code":"17478020810","type":"NDC"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":3.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478021502","type":"CDM"},{"code":"17478021502","type":"NDC"}],"standard_charges":[{"gross_charge":52.69,"discounted_cash":18.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478021505","type":"CDM"},{"code":"17478021505","type":"NDC"}],"standard_charges":[{"gross_charge":70.63,"discounted_cash":24.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BACITRACIN-POLYMYXIN B OPHTH OINT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx17478023835","type":"CDM"},{"code":"17478023835","type":"NDC"}],"standard_charges":[{"gross_charge":18.48,"discounted_cash":6.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUORESCEIN SODIUM IV SOLN 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478025310","type":"CDM"},{"code":"A9612","type":"HCPCS"},{"code":"17478025310","type":"NDC"}],"standard_charges":[{"gross_charge":768.99,"discounted_cash":269.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478028810","type":"CDM"},{"code":"17478028810","type":"NDC"}],"standard_charges":[{"gross_charge":9.73,"discounted_cash":3.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx17478028811","type":"CDM"},{"code":"17478028811","type":"NDC"}],"standard_charges":[{"gross_charge":13.92,"discounted_cash":4.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478054005","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"17478054005","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ADENOSINE IV SOLN 6 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478054225","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"17478054225","type":"NDC"}],"standard_charges":[{"gross_charge":98.2,"discounted_cash":34.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MALEATE OPHTH SOLN 2-0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx17478060510","type":"CDM"},{"code":"17478060510","type":"NDC"}],"standard_charges":[{"gross_charge":290.49,"discounted_cash":101.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POLYMYXIN B-TRIMETHOPRIM OPHTH SOLN 10000 UNIT/ML-0.1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx17478070311","type":"CDM"},{"code":"17478070311","type":"NDC"}],"standard_charges":[{"gross_charge":14.17,"discounted_cash":4.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478071110","type":"CDM"},{"code":"17478071110","type":"NDC"}],"standard_charges":[{"gross_charge":9.78,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx17478071130","type":"CDM"},{"code":"17478071130","type":"NDC"}],"standard_charges":[{"gross_charge":100.84,"discounted_cash":35.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OFLOXACIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478071310","type":"CDM"},{"code":"17478071310","type":"NDC"}],"standard_charges":[{"gross_charge":23.05,"discounted_cash":8.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BRIMONIDINE TARTRATE OPHTH SOLN 0.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478071510","type":"CDM"},{"code":"17478071510","type":"NDC"}],"standard_charges":[{"gross_charge":20.23,"discounted_cash":7.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"APRACLONIDINE HCL OPHTH SOLN 0.5% (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478071610","type":"CDM"},{"code":"17478071610","type":"NDC"}],"standard_charges":[{"gross_charge":97.36,"discounted_cash":34.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROGESTERONE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17478076610","type":"CDM"},{"code":"17478076610","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478081110","type":"CDM"},{"code":"17478081110","type":"NDC"}],"standard_charges":[{"gross_charge":3.81,"discounted_cash":1.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESOMEPRAZOLE SODIUM FOR INTRAVENOUS SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17478085010","type":"CDM"},{"code":"J1370","type":"HCPCS"},{"code":"17478085010","type":"NDC"}],"standard_charges":[{"gross_charge":100.64,"discounted_cash":35.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478093705","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"17478093705","type":"NDC"}],"standard_charges":[{"gross_charge":94.28,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"L-METHYLFOLATE W/ VIT B6-VIT B12 TAB 3-35-2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx18011080690","type":"CDM"},{"code":"18011080690","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"INFLUENZA VIRUS VACCINE SPLIT PF SUSP PREF SYRINGE 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx19515081052","type":"CDM"},{"code":"90656","type":"HCPCS"},{"code":"19515081052","type":"NDC"}],"standard_charges":[{"gross_charge":162.96,"discounted_cash":57.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TESTOSTERONE TD GEL 25 MG/2.5GM (1%)","drug_information":{"unit":2.5,"type":"GM"},"code_information":[{"code":"Rx21922001955","type":"CDM"},{"code":"21922001955","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":2.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MUPIROCIN CALCIUM CREAM 2%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx21922002904","type":"CDM"},{"code":"21922002904","type":"NDC"}],"standard_charges":[{"gross_charge":34.35,"discounted_cash":12.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155000401","type":"CDM"},{"code":"23155000401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155000801","type":"CDM"},{"code":"23155000801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VERAPAMIL HCL TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155002701","type":"CDM"},{"code":"23155002701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEFLUNOMIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155004303","type":"CDM"},{"code":"23155004303","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLYBURIDE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155005701","type":"CDM"},{"code":"23155005701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METHIMAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155007101","type":"CDM"},{"code":"23155007101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155009201","type":"CDM"},{"code":"23155009201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155009401","type":"CDM"},{"code":"23155009401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155010201","type":"CDM"},{"code":"23155010201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METFORMIN HCL TAB 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155010401","type":"CDM"},{"code":"23155010401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155011001","type":"CDM"},{"code":"23155011001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DOXYCYCLINE MONOHYDRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155013525","type":"CDM"},{"code":"23155013525","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ONDANSETRON HCL INJ 40 MG/20ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155016831","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"23155016831","type":"NDC"}],"standard_charges":[{"gross_charge":98.91,"discounted_cash":34.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx23155018631","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"23155018631","type":"NDC"}],"standard_charges":[{"gross_charge":3213.2,"discounted_cash":1124.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CIDOFOVIR IV INJ 75 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx23155021631","type":"CDM"},{"code":"J0740","type":"HCPCS"},{"code":"23155021631","type":"NDC"}],"standard_charges":[{"gross_charge":6409.98,"discounted_cash":2243.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx23155024031","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"23155024031","type":"NDC"}],"standard_charges":[{"gross_charge":94.27,"discounted_cash":32.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 25 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155024601","type":"CDM"},{"code":"23155024601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ACETAZOLAMIDE TAB 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155028701","type":"CDM"},{"code":"23155028701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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":"Rx23155034543","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"23155034543","type":"NDC"}],"standard_charges":[{"gross_charge":101.35,"discounted_cash":35.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx23155047341","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"23155047341","type":"NDC"}],"standard_charges":[{"gross_charge":93.57,"discounted_cash":32.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155054742","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"23155054742","type":"NDC"}],"standard_charges":[{"gross_charge":93.59,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx23155062041","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"23155062041","type":"NDC"}],"standard_charges":[{"gross_charge":93.86,"discounted_cash":32.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx23155066043","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"23155066043","type":"NDC"}],"standard_charges":[{"gross_charge":548.48,"discounted_cash":191.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ENALAPRIL MALEATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155070501","type":"CDM"},{"code":"23155070501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155075101","type":"CDM"},{"code":"23155075101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155087301","type":"CDM"},{"code":"23155087301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DICLOFENAC SODIUM SOLN 1.5%","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx23635031015","type":"CDM"},{"code":"23635031015","type":"NDC"}],"standard_charges":[{"gross_charge":339.07,"discounted_cash":118.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TOBRAMYCIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208029005","type":"CDM"},{"code":"24208029005","type":"NDC"}],"standard_charges":[{"gross_charge":16.74,"discounted_cash":5.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LOTEPREDNOL ETABONATE OPHTH SUSP 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208029905","type":"CDM"},{"code":"24208029905","type":"NDC"}],"standard_charges":[{"gross_charge":443.92,"discounted_cash":155.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LOTEPREDNOL ETABONATE OPHTH SUSP 0.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208035305","type":"CDM"},{"code":"24208035305","type":"NDC"}],"standard_charges":[{"gross_charge":417.33,"discounted_cash":146.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARTEOLOL HCL OPHTH SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208036705","type":"CDM"},{"code":"24208036705","type":"NDC"}],"standard_charges":[{"gross_charge":18.49,"discounted_cash":6.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IPRATROPIUM BROMIDE NASAL SOLN 0.03% (21 MCG/SPRAY)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx24208039830","type":"CDM"},{"code":"24208039830","type":"NDC"}],"standard_charges":[{"gross_charge":50.35,"discounted_cash":17.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IPRATROPIUM BROMIDE NASAL SOLN 0.06% (42 MCG/SPRAY)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx24208039915","type":"CDM"},{"code":"24208039915","type":"NDC"}],"standard_charges":[{"gross_charge":52.02,"discounted_cash":18.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OFLOXACIN OTIC SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208041005","type":"CDM"},{"code":"24208041005","type":"NDC"}],"standard_charges":[{"gross_charge":183.21,"discounted_cash":64.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BRIMONIDINE TARTRATE OPHTH SOLN 0.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208041105","type":"CDM"},{"code":"24208041105","type":"NDC"}],"standard_charges":[{"gross_charge":20.67,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BRIMONIDINE TARTRATE OPHTH SOLN 0.2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx24208041110","type":"CDM"},{"code":"24208041110","type":"NDC"}],"standard_charges":[{"gross_charge":38.83,"discounted_cash":13.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LEVOBUNOLOL HCL OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208050505","type":"CDM"},{"code":"24208050505","type":"NDC"}],"standard_charges":[{"gross_charge":5.37,"discounted_cash":1.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TROPICAMIDE OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx24208059064","type":"CDM"},{"code":"24208059064","type":"NDC"}],"standard_charges":[{"gross_charge":27.92,"discounted_cash":9.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-HC OTIC SOLN 1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx24208063110","type":"CDM"},{"code":"24208063110","type":"NDC"}],"standard_charges":[{"gross_charge":80.19,"discounted_cash":28.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx24208075006","type":"CDM"},{"code":"24208075006","type":"NDC"}],"standard_charges":[{"gross_charge":21.73,"discounted_cash":7.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208075060","type":"CDM"},{"code":"24208075060","type":"NDC"}],"standard_charges":[{"gross_charge":11.26,"discounted_cash":3.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH SUSP 0.1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208083060","type":"CDM"},{"code":"24208083060","type":"NDC"}],"standard_charges":[{"gross_charge":21.85,"discounted_cash":7.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24338010013","type":"CDM"},{"code":"24338010013","type":"NDC"}],"standard_charges":[{"gross_charge":16.92,"discounted_cash":5.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ERYTHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24338010213","type":"CDM"},{"code":"24338010213","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":3.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ERYTHROMYCIN W/ DELAYED RELEASE PARTICLES CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24338012013","type":"CDM"},{"code":"24338012013","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ALUM (POTASSIUM) POWDER","drug_information":{"unit":10.0,"type":"GM"},"code_information":[{"code":"Rx24357030001","type":"CDM"},{"code":"24357030001","type":"NDC"}],"standard_charges":[{"gross_charge":821.52,"discounted_cash":287.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24979003701","type":"CDM"},{"code":"24979003701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROPAFENONE HCL CAP ER 12HR 225 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24979008504","type":"CDM"},{"code":"24979008504","type":"NDC"}],"standard_charges":[{"gross_charge":2.96,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MYCOPHENOLATE SODIUM TAB DR 180 MG (MYCOPHENOLIC ACID EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24979016044","type":"CDM"},{"code":"J7518","type":"HCPCS"},{"code":"24979016044","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIGOXIN TAB 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24987024256","type":"CDM"},{"code":"24987024256","type":"NDC"}],"standard_charges":[{"gross_charge":14.62,"discounted_cash":5.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx25021005301","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"25021005301","type":"NDC"}],"standard_charges":[{"gross_charge":93.44,"discounted_cash":32.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021010510","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"25021010510","type":"NDC"}],"standard_charges":[{"gross_charge":93.94,"discounted_cash":32.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021010910","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"25021010910","type":"NDC"}],"standard_charges":[{"gross_charge":96.41,"discounted_cash":33.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021011382","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021011382","type":"NDC"}],"standard_charges":[{"gross_charge":248.7,"discounted_cash":87.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx25021011382","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021011382","type":"NDC"}],"standard_charges":[{"gross_charge":380.48,"discounted_cash":133.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx25021011382","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021011382","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx25021011387","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021011387","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 600 MG/4ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021011504","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"25021011504","type":"NDC"}],"standard_charges":[{"gross_charge":94.35,"discounted_cash":33.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEFUROXIME SODIUM FOR IV SOLN 1.5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021011920","type":"CDM"},{"code":"J0697","type":"HCPCS"},{"code":"25021011920","type":"NDC"}],"standard_charges":[{"gross_charge":96.68,"discounted_cash":33.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEFTAZIDIME FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021012850","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"25021012850","type":"NDC"}],"standard_charges":[{"gross_charge":101.49,"discounted_cash":35.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOFLOXACIN IV SOLN 25 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx25021013020","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"25021013020","type":"NDC"}],"standard_charges":[{"gross_charge":98.85,"discounted_cash":34.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx25021013283","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"25021013283","type":"NDC"}],"standard_charges":[{"gross_charge":246.05,"discounted_cash":86.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021013410","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"25021013410","type":"NDC"}],"standard_charges":[{"gross_charge":94.5,"discounted_cash":33.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021013510","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"25021013510","type":"NDC"}],"standard_charges":[{"gross_charge":94.64,"discounted_cash":33.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021013610","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"25021013610","type":"NDC"}],"standard_charges":[{"gross_charge":95.17,"discounted_cash":33.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021013720","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"25021013720","type":"NDC"}],"standard_charges":[{"gross_charge":96.27,"discounted_cash":33.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021014330","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"25021014330","type":"NDC"}],"standard_charges":[{"gross_charge":101.31,"discounted_cash":35.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXACILLIN SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021014610","type":"CDM"},{"code":"J2700","type":"HCPCS"},{"code":"25021014610","type":"NDC"}],"standard_charges":[{"gross_charge":115.58,"discounted_cash":40.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 750 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021014720","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"25021014720","type":"NDC"}],"standard_charges":[{"gross_charge":97.92,"discounted_cash":34.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021015630","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"25021015630","type":"NDC"}],"standard_charges":[{"gross_charge":98.85,"discounted_cash":34.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"COLISTIMETHATE SOD FOR INJ 150 MG (COLISTIN BASE ACTIVITY)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021015910","type":"CDM"},{"code":"J0770","type":"HCPCS"},{"code":"25021015910","type":"NDC"}],"standard_charges":[{"gross_charge":249.2,"discounted_cash":87.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OXACILLIN SODIUM FOR IV SOLN 10 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021016399","type":"CDM"},{"code":"J2700","type":"HCPCS"},{"code":"25021016399","type":"NDC"}],"standard_charges":[{"gross_charge":1130.11,"discounted_cash":395.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx25021016430","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"25021016430","type":"NDC"}],"standard_charges":[{"gross_charge":99.71,"discounted_cash":34.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021019010","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"25021019010","type":"NDC"}],"standard_charges":[{"gross_charge":138.09,"discounted_cash":48.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021019110","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"25021019110","type":"NDC"}],"standard_charges":[{"gross_charge":245.84,"discounted_cash":86.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 150 MG/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx25021020215","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"25021020215","type":"NDC"}],"standard_charges":[{"gross_charge":289.01,"discounted_cash":101.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUDARABINE PHOSPHATE FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021020505","type":"CDM"},{"code":"J9185","type":"HCPCS"},{"code":"25021020505","type":"NDC"}],"standard_charges":[{"gross_charge":753.23,"discounted_cash":263.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOPOTECAN HCL FOR INJ 4 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021020606","type":"CDM"},{"code":"J9351","type":"HCPCS"},{"code":"25021020606","type":"NDC"}],"standard_charges":[{"gross_charge":688.7,"discounted_cash":241.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx25021020725","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"25021020725","type":"NDC"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXALIPLATIN FOR IV INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021021250","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"25021021250","type":"NDC"}],"standard_charges":[{"gross_charge":776.57,"discounted_cash":271.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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":"Rx25021024501","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"25021024501","type":"NDC"}],"standard_charges":[{"gross_charge":224.05,"discounted_cash":78.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PACLITAXEL IV CONC 100 MG/16.7ML (6 MG/ML)","drug_information":{"unit":16.7,"type":"ML"},"code_information":[{"code":"Rx25021025517","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"25021025517","type":"NDC"}],"standard_charges":[{"gross_charge":270.29,"discounted_cash":94.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ADENOSINE IV SOLN 3 MG/ML (DIAGNOSTIC)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx25021030720","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"25021030720","type":"NDC"}],"standard_charges":[{"gross_charge":549.02,"discounted_cash":192.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021031002","type":"CDM"},{"code":"25021031002","type":"NDC"}],"standard_charges":[{"gross_charge":1344.33,"discounted_cash":470.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx25021031110","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"25021031110","type":"NDC"}],"standard_charges":[{"gross_charge":93.37,"discounted_cash":32.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021031905","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"25021031905","type":"NDC"}],"standard_charges":[{"gross_charge":93.95,"discounted_cash":32.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 50 MG/10ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021031910","type":"CDM"},{"code":"25021031910","type":"NDC"}],"standard_charges":[{"gross_charge":93.73,"discounted_cash":32.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021032104","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"25021032104","type":"NDC"}],"standard_charges":[{"gross_charge":93.86,"discounted_cash":32.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) PF INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021040102","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"25021040102","type":"NDC"}],"standard_charges":[{"gross_charge":97.97,"discounted_cash":34.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx25021040201","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"25021040201","type":"NDC"}],"standard_charges":[{"gross_charge":93.38,"discounted_cash":32.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx25021041070","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"25021041070","type":"NDC"}],"standard_charges":[{"gross_charge":95.17,"discounted_cash":33.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TRANEXAMIC ACID-SODIUM CHLORIDE IV SOLN 1000 MG/100ML-0.7%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021041882","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"25021041882","type":"NDC"}],"standard_charges":[{"gross_charge":246.2,"discounted_cash":86.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 100 MCG/ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx25021045201","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"25021045201","type":"NDC"}],"standard_charges":[{"gross_charge":97.74,"discounted_cash":34.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 500 MCG/ML (0.5 MG/ML)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx25021045301","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"25021045301","type":"NDC"}],"standard_charges":[{"gross_charge":95.51,"discounted_cash":33.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx25021047401","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"25021047401","type":"NDC"}],"standard_charges":[{"gross_charge":95.67,"discounted_cash":33.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CAFFEINE CITRATE INJ 60 MG/3ML (10 MG/ML BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx25021060103","type":"CDM"},{"code":"J0706","type":"HCPCS"},{"code":"25021060103","type":"NDC"}],"standard_charges":[{"gross_charge":97.26,"discounted_cash":34.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx25021060851","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"25021060851","type":"NDC"}],"standard_charges":[{"gross_charge":113.12,"discounted_cash":39.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021061282","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"25021061282","type":"NDC"}],"standard_charges":[{"gross_charge":243.9,"discounted_cash":85.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx25021065502","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"25021065502","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021065710","type":"CDM"},{"code":"25021065710","type":"NDC"}],"standard_charges":[{"gross_charge":96.24,"discounted_cash":33.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx25021067187","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"25021067187","type":"NDC"}],"standard_charges":[{"gross_charge":93.94,"discounted_cash":32.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"KETAMINE HCL INJ 50 MG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx25021068310","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"25021068310","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.3333333333333333333,"type":"ML"},"code_information":[{"code":"Rx25021070101","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"25021070101","type":"NDC"}],"standard_charges":[{"gross_charge":93.46,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx25021078005","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"25021078005","type":"NDC"}],"standard_charges":[{"gross_charge":94.23,"discounted_cash":32.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TOPOTECAN HCL FOR INJ 4 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021082406","type":"CDM"},{"code":"J9351","type":"HCPCS"},{"code":"25021082406","type":"NDC"}],"standard_charges":[{"gross_charge":688.7,"discounted_cash":241.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25208000305","type":"CDM"},{"code":"25208000305","type":"NDC"}],"standard_charges":[{"gross_charge":517.44,"discounted_cash":181.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241005103","type":"CDM"},{"code":"27241005103","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241009803","type":"CDM"},{"code":"27241009803","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RANOLAZINE TAB ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241012502","type":"CDM"},{"code":"27241012502","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241015504","type":"CDM"},{"code":"27241015504","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241015604","type":"CDM"},{"code":"27241015604","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241015704","type":"CDM"},{"code":"27241015704","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CAPTOPRIL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241016001","type":"CDM"},{"code":"27241016001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CAPTOPRIL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241016201","type":"CDM"},{"code":"27241016201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241028601","type":"CDM"},{"code":"27241028601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27437005057","type":"CDM"},{"code":"27437005057","type":"NDC"}],"standard_charges":[{"gross_charge":86.54,"discounted_cash":30.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DANTROLENE SODIUM FOR IV SOLN 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27505000367","type":"CDM"},{"code":"27505000367","type":"NDC"}],"standard_charges":[{"gross_charge":690.67,"discounted_cash":241.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27808015701","type":"CDM"},{"code":"27808015701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx29033000301","type":"CDM"},{"code":"29033000301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CINACALCET HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722010330","type":"CDM"},{"code":"31722010330","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FOSINOPRIL SODIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722020190","type":"CDM"},{"code":"31722020190","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx31722039410","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"31722039410","type":"NDC"}],"standard_charges":[{"gross_charge":93.49,"discounted_cash":32.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx31722039433","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"31722039433","type":"NDC"}],"standard_charges":[{"gross_charge":93.49,"discounted_cash":32.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CITALOPRAM HYDROBROMIDE ORAL SOLN 10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx31722056424","type":"CDM"},{"code":"31722056424","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342002907","type":"CDM"},{"code":"33342002907","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE ORALLY DISINTEGRATING TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342003007","type":"CDM"},{"code":"33342003007","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VALSARTAN TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342006310","type":"CDM"},{"code":"33342006310","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VALSARTAN TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342006410","type":"CDM"},{"code":"33342006410","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TOLTERODINE TARTRATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342009809","type":"CDM"},{"code":"33342009809","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SEVELAMER CARBONATE TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342021558","type":"CDM"},{"code":"33342021558","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33358024620","type":"CDM"},{"code":"33358024620","type":"NDC"}],"standard_charges":[{"gross_charge":3.63,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.31 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx35573044325","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"35573044325","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx36000000206","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"36000000206","type":"NDC"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx36000000206","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"36000000206","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx36000000206","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"36000000206","type":"NDC"}],"standard_charges":[{"gross_charge":246.5,"discounted_cash":86.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx36000000306","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"36000000306","type":"NDC"}],"standard_charges":[{"gross_charge":241.45,"discounted_cash":84.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx36000000924","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"36000000924","type":"NDC"}],"standard_charges":[{"gross_charge":243.7,"discounted_cash":85.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx36000000924","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"36000000924","type":"NDC"}],"standard_charges":[{"gross_charge":242.1,"discounted_cash":84.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ONDANSETRON HCL INJ 40 MG/20ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx36000001301","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"36000001301","type":"NDC"}],"standard_charges":[{"gross_charge":93.36,"discounted_cash":32.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx36000016210","type":"CDM"},{"code":"36000016210","type":"NDC"}],"standard_charges":[{"gross_charge":94.62,"discounted_cash":33.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx36000030660","type":"CDM"},{"code":"J0131","type":"HCPCS"},{"code":"36000030660","type":"NDC"}],"standard_charges":[{"gross_charge":98.9,"discounted_cash":34.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TRICHLOROACETIC ACID (BULK) POWDER","drug_information":{"unit":100.0,"type":"GM"},"code_information":[{"code":"Rx38779010005","type":"CDM"},{"code":"38779010005","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHENOL LIQUID (BULK)","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx38779193808","type":"CDM"},{"code":"38779193808","type":"NDC"}],"standard_charges":[{"gross_charge":52.5,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARBOMER GEL BASE","drug_information":{"unit":100.0,"type":"GM"},"code_information":[{"code":"Rx38779229805","type":"CDM"},{"code":"38779229805","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":4.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POT PHOS MONOBASIC W/SOD PHOS DI & MONOBAS TAB 155-852-130MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39328010710","type":"CDM"},{"code":"39328010710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POLYMYXIN B SULFATE FOR INJ 500000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822016605","type":"CDM"},{"code":"39822016605","type":"NDC"}],"standard_charges":[{"gross_charge":100.66,"discounted_cash":35.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POLYMYXIN B SULFATE FOR INJ 500000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822016607","type":"CDM"},{"code":"39822016607","type":"NDC"}],"standard_charges":[{"gross_charge":117.82,"discounted_cash":41.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ACETAZOLAMIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822019007","type":"CDM"},{"code":"J1120","type":"HCPCS"},{"code":"39822019007","type":"NDC"}],"standard_charges":[{"gross_charge":327.04,"discounted_cash":114.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BACITRACIN INTRAMUSCULAR FOR SOLN 50000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822027702","type":"CDM"},{"code":"39822027702","type":"NDC"}],"standard_charges":[{"gross_charge":101.67,"discounted_cash":35.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx39822050004","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"39822050004","type":"NDC"}],"standard_charges":[{"gross_charge":95.32,"discounted_cash":33.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"STREPTOMYCIN SULFATE FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822070601","type":"CDM"},{"code":"J3000","type":"HCPCS"},{"code":"39822070601","type":"NDC"}],"standard_charges":[{"gross_charge":778.6,"discounted_cash":272.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx39822100001","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"39822100001","type":"NDC"}],"standard_charges":[{"gross_charge":98.57,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IBUPROFEN LYSINE IV SOLN 10 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx39822103002","type":"CDM"},{"code":"39822103002","type":"NDC"}],"standard_charges":[{"gross_charge":2733.29,"discounted_cash":956.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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":"Rx39822420001","type":"CDM"},{"code":"39822420001","type":"NDC"}],"standard_charges":[{"gross_charge":94.36,"discounted_cash":33.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METHOHEXITAL SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42023010501","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"42023010501","type":"NDC"}],"standard_charges":[{"gross_charge":1149.24,"discounted_cash":402.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NEOMYCIN-COLISTIN-HC-THONZONIUM OTIC SUSP 3.3-3-10-0.5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx42023010801","type":"CDM"},{"code":"42023010801","type":"NDC"}],"standard_charges":[{"gross_charge":35.76,"discounted_cash":12.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DANTROLENE SODIUM CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42023012501","type":"CDM"},{"code":"42023012501","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42023014025","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"42023014025","type":"NDC"}],"standard_charges":[{"gross_charge":94.12,"discounted_cash":32.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx42023016425","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"42023016425","type":"NDC"}],"standard_charges":[{"gross_charge":95.51,"discounted_cash":33.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ARGATROBAN INJ 250 MG/2.5ML (CONCENTRATE FOR IV INFUSION)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx42023018201","type":"CDM"},{"code":"J0883","type":"HCPCS"},{"code":"42023018201","type":"NDC"}],"standard_charges":[{"gross_charge":1231.88,"discounted_cash":431.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CALCITONIN (SALMON) INJ 200 UNIT/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx42023020501","type":"CDM"},{"code":"J0630","type":"HCPCS"},{"code":"42023020501","type":"NDC"}],"standard_charges":[{"gross_charge":994.72,"discounted_cash":348.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"THYROID TAB 60 MG (1 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42192033001","type":"CDM"},{"code":"42192033001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SALSALATE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42192036510","type":"CDM"},{"code":"42192036510","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SALSALATE TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42192036610","type":"CDM"},{"code":"42192036610","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN ORAL SOLN 250 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx42192060816","type":"CDM"},{"code":"42192060816","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE OINT 5%","drug_information":{"unit":35.44,"type":"GM"},"code_information":[{"code":"Rx42291037935","type":"CDM"},{"code":"42291037935","type":"NDC"}],"standard_charges":[{"gross_charge":54.7,"discounted_cash":19.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292000101","type":"CDM"},{"code":"42292000101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 88 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292003820","type":"CDM"},{"code":"42292003820","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 137 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292004101","type":"CDM"},{"code":"42292004101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 137 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292004120","type":"CDM"},{"code":"42292004120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 130 MG/ML","drug_information":{"unit":0.3846153846153846154,"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: JVCPCT LOCATION"}]},{"description":"CARBON-14 UREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42530066044","type":"CDM"},{"code":"A4641","type":"HCPCS"},{"code":"42530066044","type":"NDC"}],"standard_charges":[{"gross_charge":567.0,"discounted_cash":198.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | NDC EA = 1 CAPSULE"}]},{"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: JVCPCT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx42571013725","type":"CDM"},{"code":"42571013725","type":"NDC"}],"standard_charges":[{"gross_charge":12.39,"discounted_cash":4.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 875-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42571016242","type":"CDM"},{"code":"42571016242","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AZITHROMYCIN FOR SUSP 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx42806014731","type":"CDM"},{"code":"42806014731","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806033901","type":"CDM"},{"code":"42806033901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"URSODIOL CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806050301","type":"CDM"},{"code":"42806050301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OMEGA-3-ACID ETHYL ESTERS CAP 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806055212","type":"CDM"},{"code":"42806055212","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858050103","type":"CDM"},{"code":"42858050103","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 8 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858050203","type":"CDM"},{"code":"J0571","type":"HCPCS"},{"code":"42858050203","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SALSALATE TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42937070410","type":"CDM"},{"code":"42937070410","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx43066000710","type":"CDM"},{"code":"43066000710","type":"NDC"}],"standard_charges":[{"gross_charge":93.9,"discounted_cash":32.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43066015410","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"43066015410","type":"NDC"}],"standard_charges":[{"gross_charge":93.99,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYOSCYAMINE SULFATE SL TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43199001101","type":"CDM"},{"code":"43199001101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCORTISONE ACETATE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43199002112","type":"CDM"},{"code":"43199002112","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PEG 3350-KCL-NA BICARB-NACL-NA SULFATE FOR SOLN 236 GM","drug_information":{"unit":4000.0,"type":"ML"},"code_information":[{"code":"Rx43386009019","type":"CDM"},{"code":"43386009019","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MISOPROSTOL TAB 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386016106","type":"CDM"},{"code":"43386016106","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL ORALLY DISINTEGRATING TAB 10 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386058031","type":"CDM"},{"code":"43386058031","type":"NDC"}],"standard_charges":[{"gross_charge":9.84,"discounted_cash":3.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CARBIDOPA TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386098001","type":"CDM"},{"code":"43386098001","type":"NDC"}],"standard_charges":[{"gross_charge":12.11,"discounted_cash":4.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPATITIS B VACCINE RECOMB ADJUVANTED PREF SYR 20 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx43528000305","type":"CDM"},{"code":"90739","type":"HCPCS"},{"code":"43528000305","type":"NDC"}],"standard_charges":[{"gross_charge":1415.45,"discounted_cash":495.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547026810","type":"CDM"},{"code":"43547026810","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547027410","type":"CDM"},{"code":"43547027410","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IRBESARTAN TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547027703","type":"CDM"},{"code":"43547027703","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547028010","type":"CDM"},{"code":"43547028010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547033510","type":"CDM"},{"code":"43547033510","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547033710","type":"CDM"},{"code":"43547033710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547034106","type":"CDM"},{"code":"43547034106","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43547045441","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"43547045441","type":"NDC"}],"standard_charges":[{"gross_charge":94.77,"discounted_cash":33.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598007811","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"43598007811","type":"NDC"}],"standard_charges":[{"gross_charge":97.17,"discounted_cash":34.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 1000 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598013074","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"43598013074","type":"NDC"}],"standard_charges":[{"gross_charge":134.51,"discounted_cash":47.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OLANZAPINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598016630","type":"CDM"},{"code":"43598016630","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PHENYLEPHRINE HCL (PF) IV SOLN 0.5 MG/5ML (100 MCG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598017215","type":"CDM"},{"code":"J2372","type":"HCPCS"},{"code":"43598017215","type":"NDC"}],"standard_charges":[{"gross_charge":93.96,"discounted_cash":32.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 600-42.9 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43598020369","type":"CDM"},{"code":"43598020369","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 250-62.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43598020451","type":"CDM"},{"code":"43598020451","type":"NDC"}],"standard_charges":[{"gross_charge":3.57,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx43598021050","type":"CDM"},{"code":"43598021050","type":"NDC"}],"standard_charges":[{"gross_charge":17.32,"discounted_cash":6.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL SUSP (FOR IV INFUSION) 2 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx43598028335","type":"CDM"},{"code":"Q2050","type":"HCPCS"},{"code":"43598028335","type":"NDC"}],"standard_charges":[{"gross_charge":3549.33,"discounted_cash":1242.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PEMETREXED DISODIUM FOR IV SOLN 100 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598038662","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"43598038662","type":"NDC"}],"standard_charges":[{"gross_charge":258.74,"discounted_cash":90.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PEMETREXED DISODIUM FOR IV SOLN 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598038711","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"43598038711","type":"NDC"}],"standard_charges":[{"gross_charge":789.45,"discounted_cash":276.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx43598040511","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"43598040511","type":"NDC"}],"standard_charges":[{"gross_charge":97.47,"discounted_cash":34.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.63 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx43598041025","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"43598041025","type":"NDC"}],"standard_charges":[{"gross_charge":7.22,"discounted_cash":2.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BORTEZOMIB FOR INJ 3.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598042660","type":"CDM"},{"code":"J9041","type":"HCPCS"},{"code":"43598042660","type":"NDC"}],"standard_charges":[{"gross_charge":308.23,"discounted_cash":107.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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":"Rx43598054910","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"43598054910","type":"NDC"}],"standard_charges":[{"gross_charge":101.05,"discounted_cash":35.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARBOPROST TROMETHAMINE IM SOLN 250 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx43598069858","type":"CDM"},{"code":"J0675","type":"HCPCS"},{"code":"43598069858","type":"NDC"}],"standard_charges":[{"gross_charge":204.13,"discounted_cash":71.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598075260","type":"CDM"},{"code":"43598075260","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ZIPRASIDONE MESYLATE FOR INJ 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598084858","type":"CDM"},{"code":"J3486","type":"HCPCS"},{"code":"43598084858","type":"NDC"}],"standard_charges":[{"gross_charge":143.71,"discounted_cash":50.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE SOLN PREF SYR 3 MG/3ML (1 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx43598094511","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"43598094511","type":"NDC"}],"standard_charges":[{"gross_charge":94.51,"discounted_cash":33.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE SOLN PREF SYR 3 MG/3ML (1 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx43598094558","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"43598094558","type":"NDC"}],"standard_charges":[{"gross_charge":94.47,"discounted_cash":33.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43975032303","type":"CDM"},{"code":"43975032303","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx44206031025","type":"CDM"},{"code":"P9045","type":"HCPCS"},{"code":"44206031025","type":"NDC"}],"standard_charges":[{"gross_charge":369.6,"discounted_cash":129.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567010210","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"44567010210","type":"NDC"}],"standard_charges":[{"gross_charge":97.32,"discounted_cash":34.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567010310","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"44567010310","type":"NDC"}],"standard_charges":[{"gross_charge":96.32,"discounted_cash":33.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"},{"gross_charge":243.17,"discounted_cash":85.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFTAZIDIME FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567023610","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"44567023610","type":"NDC"}],"standard_charges":[{"gross_charge":98.61,"discounted_cash":34.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567043624","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"44567043624","type":"NDC"}],"standard_charges":[{"gross_charge":243.3,"discounted_cash":85.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567070125","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"44567070125","type":"NDC"}],"standard_charges":[{"gross_charge":94.17,"discounted_cash":32.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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":"Rx44567080210","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"44567080210","type":"NDC"}],"standard_charges":[{"gross_charge":97.96,"discounted_cash":34.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESMOLOL HCL INJ 2500 MG/250ML (10 MG/ML)","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx44567081110","type":"CDM"},{"code":"J1806","type":"HCPCS"},{"code":"44567081110","type":"NDC"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":375.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 40 MG/200ML IN SODIUM CHLORIDE 0.83%","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx44567085112","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"44567085112","type":"NDC"}],"standard_charges":[{"gross_charge":454.72,"discounted_cash":159.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IOBENGUANE SULFATE I 131 2.3 MCI/ML IV SOLN","drug_information":{"unit":0.217391304347826087,"type":"ML"},"code_information":[{"code":"Rx45567010001","type":"CDM"},{"code":"A9508","type":"HCPCS"},{"code":"45567010001","type":"NDC"}],"standard_charges":[{"gross_charge":3114.0,"discounted_cash":1089.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE OINT 0.5%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx45802004935","type":"CDM"},{"code":"45802004935","type":"NDC"}],"standard_charges":[{"gross_charge":6.05,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE OINT 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx45802005535","type":"CDM"},{"code":"45802005535","type":"NDC"}],"standard_charges":[{"gross_charge":6.41,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NYSTATIN CREAM 100000 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx45802005911","type":"CDM"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"gross_charge":10.53,"discounted_cash":3.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.5%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx45802006535","type":"CDM"},{"code":"45802006535","type":"NDC"}],"standard_charges":[{"gross_charge":11.29,"discounted_cash":3.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":8.5,"type":"GM"},"code_information":[{"code":"Rx45802008801","type":"CDM"},{"code":"45802008801","type":"NDC"}],"standard_charges":[{"gross_charge":49.49,"discounted_cash":17.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NITROGLYCERIN TL SOLN 0.4 MG/SPRAY (400 MCG/SPRAY)","drug_information":{"unit":4.9,"type":"GM"},"code_information":[{"code":"Rx45802021001","type":"CDM"},{"code":"45802021001","type":"NDC"}],"standard_charges":[{"gross_charge":266.56,"discounted_cash":93.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NYSTATIN-TRIAMCINOLONE OINT 100000-0.1 UNIT/GM-%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx45802024414","type":"CDM"},{"code":"45802024414","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":7.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PROMETHAZINE HCL SUPPOS 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802075800","type":"CDM"},{"code":"45802075800","type":"NDC"}],"standard_charges":[{"gross_charge":13.55,"discounted_cash":4.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLIMEPIRIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802077078","type":"CDM"},{"code":"45802077078","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DESIPRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45963034202","type":"CDM"},{"code":"45963034202","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DESIPRAMINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45963034302","type":"CDM"},{"code":"45963034302","type":"NDC"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45963055808","type":"CDM"},{"code":"45963055808","type":"NDC"}],"standard_charges":[{"gross_charge":3.64,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45963055830","type":"CDM"},{"code":"45963055830","type":"NDC"}],"standard_charges":[{"gross_charge":4.05,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx45963073355","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"45963073355","type":"NDC"}],"standard_charges":[{"gross_charge":286.69,"discounted_cash":100.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SODIUM POLYSTYRENE SULFONATE SUSP 15 GM/60ML","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx46287000601","type":"CDM"},{"code":"46287000601","type":"NDC"}],"standard_charges":[{"gross_charge":34.02,"discounted_cash":11.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL SUSP (FOR IV INFUSION) 2 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx47335004940","type":"CDM"},{"code":"Q2050","type":"HCPCS"},{"code":"47335004940","type":"NDC"}],"standard_charges":[{"gross_charge":2125.98,"discounted_cash":744.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOBRAMYCIN NEBU SOLN 300 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx47335017149","type":"CDM"},{"code":"J7682","type":"HCPCS"},{"code":"47335017149","type":"NDC"}],"standard_charges":[{"gross_charge":16.16,"discounted_cash":5.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CAFFEINE CITRATE INJ 60 MG/3ML (10 MG/ML BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx47335028927","type":"CDM"},{"code":"J0706","type":"HCPCS"},{"code":"47335028927","type":"NDC"}],"standard_charges":[{"gross_charge":366.67,"discounted_cash":128.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335038186","type":"CDM"},{"code":"47335038186","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DESMOPRESSIN ACETATE NASAL SPRAY SOLN 0.01%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx47335078891","type":"CDM"},{"code":"47335078891","type":"NDC"}],"standard_charges":[{"gross_charge":169.83,"discounted_cash":59.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GALANTAMINE HYDROBROMIDE CAP ER 24HR 8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335083583","type":"CDM"},{"code":"47335083583","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335089481","type":"CDM"},{"code":"47335089481","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335093144","type":"CDM"},{"code":"47335093144","type":"NDC"}],"standard_charges":[{"gross_charge":98.36,"discounted_cash":34.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AZELASTINE HCL OPHTH SOLN 0.05%","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx47335093890","type":"CDM"},{"code":"47335093890","type":"NDC"}],"standard_charges":[{"gross_charge":48.26,"discounted_cash":16.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALFUZOSIN HCL TAB ER 24HR 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335095688","type":"CDM"},{"code":"47335095688","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ESTRADIOL VAGINAL CREAM 0.01%","drug_information":{"unit":42.5,"type":"GM"},"code_information":[{"code":"Rx47781010444","type":"CDM"},{"code":"47781010444","type":"NDC"}],"standard_charges":[{"gross_charge":233.32,"discounted_cash":81.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESTRADIOL TD PATCH WEEKLY 0.075 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781020804","type":"CDM"},{"code":"47781020804","type":"NDC"}],"standard_charges":[{"gross_charge":22.98,"discounted_cash":8.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NITROFURANTOIN MACROCRYSTALLINE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781030701","type":"CDM"},{"code":"47781030701","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PYRIDOSTIGMINE BROMIDE TAB ER 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781033530","type":"CDM"},{"code":"47781033530","type":"NDC"}],"standard_charges":[{"gross_charge":9.29,"discounted_cash":3.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV)","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx47781038426","type":"CDM"},{"code":"47781038426","type":"NDC"}],"standard_charges":[{"gross_charge":29.13,"discounted_cash":10.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781047013","type":"CDM"},{"code":"47781047013","type":"NDC"}],"standard_charges":[{"gross_charge":14.02,"discounted_cash":4.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHENAMINE HIPPURATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781057701","type":"CDM"},{"code":"47781057701","type":"NDC"}],"standard_charges":[{"gross_charge":2.43,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx47781060191","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"47781060191","type":"NDC"}],"standard_charges":[{"gross_charge":98.43,"discounted_cash":34.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BACITRACIN-POLYMYXIN B OPHTH OINT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx48102000435","type":"CDM"},{"code":"48102000435","type":"NDC"}],"standard_charges":[{"gross_charge":12.39,"discounted_cash":4.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ERYTHROMYCIN OPHTH OINT 5 MG/GM","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx48102005711","type":"CDM"},{"code":"48102005711","type":"NDC"}],"standard_charges":[{"gross_charge":14.3,"discounted_cash":5.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PRALATREXATE IV INJ 40 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx48818000102","type":"CDM"},{"code":"J9307","type":"HCPCS"},{"code":"48818000102","type":"NDC"}],"standard_charges":[{"gross_charge":59388.8,"discounted_cash":20786.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HAEMOPHILUS B POLYSACCHARIDE CONJUGATE VACCINE FOR INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49281054505","type":"CDM"},{"code":"90648","type":"HCPCS"},{"code":"49281054505","type":"NDC"}],"standard_charges":[{"gross_charge":205.77,"discounted_cash":72.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MENINGOCOCCAL (A, C, Y, AND W-135) DIPHTH CONJUGATE VACCINE","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281058905","type":"CDM"},{"code":"90734","type":"HCPCS"},{"code":"49281058905","type":"NDC"}],"standard_charges":[{"gross_charge":1167.7,"discounted_cash":408.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"POLIOVIRUS VACCINE, IPV INJ SUSP","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281086010","type":"CDM"},{"code":"90713","type":"HCPCS"},{"code":"49281086010","type":"NDC"}],"standard_charges":[{"gross_charge":478.77,"discounted_cash":167.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BENZYLPENICILLOYL POLYLYSINE INJ 0.25 ML","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"Rx49471000105","type":"CDM"},{"code":"49471000105","type":"NDC"}],"standard_charges":[{"gross_charge":99.76,"discounted_cash":34.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49483062301","type":"CDM"},{"code":"49483062301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LAMIVUDINE ORAL SOLN 10 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx49702020548","type":"CDM"},{"code":"49702020548","type":"NDC"}],"standard_charges":[{"gross_charge":6.4,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ABACAVIR SULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49702022144","type":"CDM"},{"code":"49702022144","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":4.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.4 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49730011230","type":"CDM"},{"code":"49730011230","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.6 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49730011330","type":"CDM"},{"code":"49730011330","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OMEGA-3-ACID ETHYL ESTERS CAP 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884001908","type":"CDM"},{"code":"49884001908","type":"NDC"}],"standard_charges":[{"gross_charge":2.12,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IMIPRAMINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884005401","type":"CDM"},{"code":"49884005401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROPAFENONE HCL CAP ER 12HR 225 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884011302","type":"CDM"},{"code":"49884011302","type":"NDC"}],"standard_charges":[{"gross_charge":8.1,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CALCITONIN (SALMON) NASAL SOLN 200 UNIT/ACT","drug_information":{"unit":3.7,"type":"ML"},"code_information":[{"code":"Rx49884016111","type":"CDM"},{"code":"49884016111","type":"NDC"}],"standard_charges":[{"gross_charge":67.57,"discounted_cash":23.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROPAFENONE HCL CAP ER 12HR 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884021002","type":"CDM"},{"code":"49884021002","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":3.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884022809","type":"CDM"},{"code":"49884022809","type":"NDC"}],"standard_charges":[{"gross_charge":2.92,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884031152","type":"CDM"},{"code":"49884031152","type":"NDC"}],"standard_charges":[{"gross_charge":4.82,"discounted_cash":1.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FENTANYL CITRATE LOZENGE ON A HANDLE 400 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884046055","type":"CDM"},{"code":"49884046055","type":"NDC"}],"standard_charges":[{"gross_charge":24.59,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DIGOXIN TAB 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884049401","type":"CDM"},{"code":"49884049401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIGOXIN TAB 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884051401","type":"CDM"},{"code":"49884051401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROXYUREA CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884072401","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"49884072401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TOLVAPTAN TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884077052","type":"CDM"},{"code":"49884077052","type":"NDC"}],"standard_charges":[{"gross_charge":166.3,"discounted_cash":58.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884083009","type":"CDM"},{"code":"49884083009","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROCORTISONE ACETATE W/ PRAMOXINE PERIANAL CREAM 1-1%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx49908015030","type":"CDM"},{"code":"49908015030","type":"NDC"}],"standard_charges":[{"gross_charge":51.48,"discounted_cash":18.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111033401","type":"CDM"},{"code":"50111033401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111039301","type":"CDM"},{"code":"50111039301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111046801","type":"CDM"},{"code":"50111046801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VALPROIC ACID CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111085201","type":"CDM"},{"code":"50111085201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111091701","type":"CDM"},{"code":"50111091701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111099001","type":"CDM"},{"code":"50111099001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 3%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx50190014263","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"50190014263","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228037930","type":"CDM"},{"code":"50228037930","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228048201","type":"CDM"},{"code":"50228048201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TENECTEPLASE FOR IV SOLN KIT 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242001403","type":"CDM"},{"code":"J3101","type":"HCPCS"},{"code":"50242001403","type":"NDC"}],"standard_charges":[{"gross_charge":85206.91,"discounted_cash":29822.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ALTEPLASE FOR INJ 50 MG","drug_information":{"unit":0.52,"type":"ML"},"code_information":[{"code":"Rx50242004420","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"50242004420","type":"NDC"}],"standard_charges":[{"gross_charge":463.18,"discounted_cash":162.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ERLOTINIB HCL TAB 150 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242006401","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"50242006401","type":"NDC"}],"standard_charges":[{"gross_charge":391.68,"discounted_cash":137.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OBINUTUZUMAB SOLN FOR IV INFUSION 1000 MG/40ML (25 MG/ML)","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx50242007001","type":"CDM"},{"code":"J9301","type":"HCPCS"},{"code":"50242007001","type":"NDC"}],"standard_charges":[{"gross_charge":42848.4,"discounted_cash":14996.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALTEPLASE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242008527","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"50242008527","type":"NDC"}],"standard_charges":[{"gross_charge":90373.36,"discounted_cash":31630.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ADO-TRASTUZUMAB EMTANSINE FOR IV SOLN 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242008701","type":"CDM"},{"code":"J9354","type":"HCPCS"},{"code":"50242008701","type":"NDC"}],"standard_charges":[{"gross_charge":31757.4,"discounted_cash":11115.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ADO-TRASTUZUMAB EMTANSINE FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242008801","type":"CDM"},{"code":"J9354","type":"HCPCS"},{"code":"50242008801","type":"NDC"}],"standard_charges":[{"gross_charge":40990.35,"discounted_cash":14346.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMILORIDE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268007111","type":"CDM"},{"code":"50268007111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMILORIDE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268007115","type":"CDM"},{"code":"50268007115","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268008415","type":"CDM"},{"code":"50268008415","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BETHANECHOL CHLORIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268011415","type":"CDM"},{"code":"50268011415","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DESMOPRESSIN ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268022015","type":"CDM"},{"code":"50268022015","type":"NDC"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268032315","type":"CDM"},{"code":"50268032315","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040215","type":"CDM"},{"code":"50268040215","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040315","type":"CDM"},{"code":"50268040315","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040815","type":"CDM"},{"code":"50268040815","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268050515","type":"CDM"},{"code":"50268050515","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268054115","type":"CDM"},{"code":"50268054115","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268062711","type":"CDM"},{"code":"50268062711","type":"NDC"}],"standard_charges":[{"gross_charge":2.11,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268062911","type":"CDM"},{"code":"50268062911","type":"NDC"}],"standard_charges":[{"gross_charge":1.84,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268062913","type":"CDM"},{"code":"50268062913","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268063615","type":"CDM"},{"code":"50268063615","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268063915","type":"CDM"},{"code":"50268063915","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268064411","type":"CDM"},{"code":"50268064411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SUCRALFATE SUSP 1 GM/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50268073212","type":"CDM"},{"code":"50268073212","type":"NDC"}],"standard_charges":[{"gross_charge":11.28,"discounted_cash":3.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268074015","type":"CDM"},{"code":"50268074015","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VALGANCICLOVIR HCL TAB 450 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268078712","type":"CDM"},{"code":"50268078712","type":"NDC"}],"standard_charges":[{"gross_charge":16.98,"discounted_cash":5.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ZONISAMIDE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268081515","type":"CDM"},{"code":"50268081515","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PREDNISOLONE SOLN 15 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383004224","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"50383004224","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383008712","type":"CDM"},{"code":"50383008712","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MALEATE OPHTH SOLN 2-0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50383023310","type":"CDM"},{"code":"50383023310","type":"NDC"}],"standard_charges":[{"gross_charge":68.82,"discounted_cash":24.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CLOBETASOL PROPIONATE OINT 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx50383026815","type":"CDM"},{"code":"50383026815","type":"NDC"}],"standard_charges":[{"gross_charge":34.4,"discounted_cash":12.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx50383077930","type":"CDM"},{"code":"50383077930","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383078105","type":"CDM"},{"code":"50383078105","type":"NDC"}],"standard_charges":[{"gross_charge":6.38,"discounted_cash":2.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx50383078130","type":"CDM"},{"code":"50383078130","type":"NDC"}],"standard_charges":[{"gross_charge":14.31,"discounted_cash":5.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ACYCLOVIR SUSP 200 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383081016","type":"CDM"},{"code":"50383081016","type":"NDC"}],"standard_charges":[{"gross_charge":5.18,"discounted_cash":1.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GADOXETATE DISODIUM IV SOLN 0.25 MMOL/ML (181.43 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50419032005","type":"CDM"},{"code":"A9581","type":"HCPCS"},{"code":"50419032005","type":"NDC"}],"standard_charges":[{"gross_charge":394.71,"discounted_cash":138.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GADOBUTROL INJ 1 MMOL/ML (604.72 MG/ML),GADOBUTROL IV SOLN PREF SYR 10 MMOL/10ML,GADOBUTROL IV SOLN PREF SYR 15 MMOL/15ML,GADOBUTROL IV SOLN PREF SYR 7.5 MMOL/7.5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50419032512","type":"CDM"},{"code":"A9585","type":"HCPCS"},{"code":"50419032512","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CIPROFLOXACIN FOR ORAL SUSP 250 MG/5ML (5%) (5 GM/100ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50419077701","type":"CDM"},{"code":"50419077701","type":"NDC"}],"standard_charges":[{"gross_charge":8.96,"discounted_cash":3.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CANAGLIFLOZIN TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458014090","type":"CDM"},{"code":"50458014090","type":"NDC"}],"standard_charges":[{"gross_charge":10.03,"discounted_cash":3.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458031528","type":"CDM"},{"code":"50458031528","type":"NDC"}],"standard_charges":[{"gross_charge":17.19,"discounted_cash":6.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458039528","type":"CDM"},{"code":"50458039528","type":"NDC"}],"standard_charges":[{"gross_charge":11.34,"discounted_cash":3.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RIVAROXABAN TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057760","type":"CDM"},{"code":"50458057760","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458060128","type":"CDM"},{"code":"50458060128","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":1.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458060228","type":"CDM"},{"code":"50458060228","type":"NDC"}],"standard_charges":[{"gross_charge":6.43,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYOSCYAMINE SULFATE TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50532011210","type":"CDM"},{"code":"50532011210","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYOSCYAMINE SULFATE TAB ER 12HR 0.375 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50532011510","type":"CDM"},{"code":"50532011510","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DESIPRAMINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742011201","type":"CDM"},{"code":"50742011201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CYPROHEPTADINE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742019001","type":"CDM"},{"code":"50742019001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ACETAZOLAMIDE CAP ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742023301","type":"CDM"},{"code":"50742023301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742025130","type":"CDM"},{"code":"50742025130","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PENCICLOVIR CREAM 1%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx50816062405","type":"CDM"},{"code":"50816062405","type":"NDC"}],"standard_charges":[{"gross_charge":295.8,"discounted_cash":103.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METOLAZONE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079002301","type":"CDM"},{"code":"51079002301","type":"NDC"}],"standard_charges":[{"gross_charge":3.27,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079005101","type":"CDM"},{"code":"51079005101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079006701","type":"CDM"},{"code":"51079006701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007601","type":"CDM"},{"code":"51079007601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MIRTAZAPINE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079008601","type":"CDM"},{"code":"51079008601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MIRTAZAPINE TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079008720","type":"CDM"},{"code":"51079008720","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079009301","type":"CDM"},{"code":"51079009301","type":"NDC"}],"standard_charges":[{"gross_charge":3.18,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079009303","type":"CDM"},{"code":"51079009303","type":"NDC"}],"standard_charges":[{"gross_charge":4.14,"discounted_cash":1.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079010701","type":"CDM"},{"code":"51079010701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079011801","type":"CDM"},{"code":"51079011801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079012617","type":"CDM"},{"code":"51079012617","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079014501","type":"CDM"},{"code":"51079014501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE TAB 300-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079016101","type":"CDM"},{"code":"51079016101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079016920","type":"CDM"},{"code":"51079016920","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079017001","type":"CDM"},{"code":"51079017001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019701","type":"CDM"},{"code":"51079019701","type":"NDC"}],"standard_charges":[{"gross_charge":13.47,"discounted_cash":4.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019703","type":"CDM"},{"code":"51079019703","type":"NDC"}],"standard_charges":[{"gross_charge":13.47,"discounted_cash":4.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019801","type":"CDM"},{"code":"51079019801","type":"NDC"}],"standard_charges":[{"gross_charge":14.05,"discounted_cash":4.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020801","type":"CDM"},{"code":"51079020801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020901","type":"CDM"},{"code":"51079020901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020920","type":"CDM"},{"code":"51079020920","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METRONIDAZOLE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079021601","type":"CDM"},{"code":"51079021601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079021701","type":"CDM"},{"code":"51079021701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079029401","type":"CDM"},{"code":"51079029401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079030001","type":"CDM"},{"code":"51079030001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079037901","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"51079037901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARBAMAZEPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079038501","type":"CDM"},{"code":"51079038501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079038601","type":"CDM"},{"code":"51079038601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079039101","type":"CDM"},{"code":"51079039101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079039201","type":"CDM"},{"code":"51079039201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079040001","type":"CDM"},{"code":"51079040001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079041020","type":"CDM"},{"code":"51079041020","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TEMAZEPAM CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079041901","type":"CDM"},{"code":"51079041901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLIMEPIRIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079042501","type":"CDM"},{"code":"51079042501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLIMEPIRIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079042520","type":"CDM"},{"code":"51079042520","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DOXEPIN HCL CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079043801","type":"CDM"},{"code":"51079043801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044001","type":"CDM"},{"code":"51079044001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044201","type":"CDM"},{"code":"51079044201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 150 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044501","type":"CDM"},{"code":"51079044501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CAPECITABINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079051005","type":"CDM"},{"code":"J8522","type":"HCPCS"},{"code":"51079051005","type":"NDC"}],"standard_charges":[{"gross_charge":48.65,"discounted_cash":17.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079051901","type":"CDM"},{"code":"51079051901","type":"NDC"}],"standard_charges":[{"gross_charge":7.23,"discounted_cash":2.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079052001","type":"CDM"},{"code":"51079052001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079054201","type":"CDM"},{"code":"51079054201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079055801","type":"CDM"},{"code":"51079055801","type":"NDC"}],"standard_charges":[{"gross_charge":29.59,"discounted_cash":10.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PRAZOSIN HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079063120","type":"CDM"},{"code":"51079063120","type":"NDC"}],"standard_charges":[{"gross_charge":2.83,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ALBUTEROL SULFATE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079065801","type":"CDM"},{"code":"51079065801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079067005","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"51079067005","type":"NDC"}],"standard_charges":[{"gross_charge":3.65,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLARITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079067201","type":"CDM"},{"code":"51079067201","type":"NDC"}],"standard_charges":[{"gross_charge":6.88,"discounted_cash":2.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072301","type":"CDM"},{"code":"51079072301","type":"NDC"}],"standard_charges":[{"gross_charge":4.93,"discounted_cash":1.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072401","type":"CDM"},{"code":"51079072401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOPIRAMATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072601","type":"CDM"},{"code":"51079072601","type":"NDC"}],"standard_charges":[{"gross_charge":3.83,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079076601","type":"CDM"},{"code":"51079076601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079077720","type":"CDM"},{"code":"51079077720","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079078901","type":"CDM"},{"code":"51079078901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079080101","type":"CDM"},{"code":"51079080101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079080120","type":"CDM"},{"code":"51079080120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079080601","type":"CDM"},{"code":"51079080601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GLIPIZIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079081101","type":"CDM"},{"code":"51079081101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GALANTAMINE HYDROBROMIDE TAB 12 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079085401","type":"CDM"},{"code":"51079085401","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CAPTOPRIL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079086301","type":"CDM"},{"code":"51079086301","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LAMOTRIGINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079086501","type":"CDM"},{"code":"51079086501","type":"NDC"}],"standard_charges":[{"gross_charge":8.96,"discounted_cash":3.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LAMOTRIGINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079086601","type":"CDM"},{"code":"51079086601","type":"NDC"}],"standard_charges":[{"gross_charge":9.76,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"INDAPAMIDE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079086801","type":"CDM"},{"code":"51079086801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"INDAPAMIDE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079086820","type":"CDM"},{"code":"51079086820","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLYBURIDE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079087201","type":"CDM"},{"code":"51079087201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLYBURIDE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079087220","type":"CDM"},{"code":"51079087220","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLYBURIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079087301","type":"CDM"},{"code":"51079087301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLYBURIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079087317","type":"CDM"},{"code":"51079087317","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CLONAZEPAM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088301","type":"CDM"},{"code":"51079088301","type":"NDC"}],"standard_charges":[{"gross_charge":1.86,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088420","type":"CDM"},{"code":"51079088420","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079089201","type":"CDM"},{"code":"51079089201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079089401","type":"CDM"},{"code":"51079089401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079090601","type":"CDM"},{"code":"51079090601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL CAP ER 12HR 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092501","type":"CDM"},{"code":"51079092501","type":"NDC"}],"standard_charges":[{"gross_charge":4.33,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL CAP ER 12HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092601","type":"CDM"},{"code":"51079092601","type":"NDC"}],"standard_charges":[{"gross_charge":6.05,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LABETALOL HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092901","type":"CDM"},{"code":"51079092901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TERAZOSIN HCL CAP 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093801","type":"CDM"},{"code":"51079093801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPROPION HCL TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079094301","type":"CDM"},{"code":"51079094301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079095901","type":"CDM"},{"code":"51079095901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUSPIRONE HCL TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079096001","type":"CDM"},{"code":"51079096001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SPIRONOLACTONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079097901","type":"CDM"},{"code":"51079097901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FLUVOXAMINE MALEATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079099201","type":"CDM"},{"code":"51079099201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BRENTUXIMAB VEDOTIN FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51144005001","type":"CDM"},{"code":"J9042","type":"HCPCS"},{"code":"51144005001","type":"NDC"}],"standard_charges":[{"gross_charge":44411.85,"discounted_cash":15544.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHENTOLAMINE MESYLATE FOR INJ 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51224001220","type":"CDM"},{"code":"J2760","type":"HCPCS"},{"code":"51224001220","type":"NDC"}],"standard_charges":[{"gross_charge":3276.56,"discounted_cash":1146.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx51224001301","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"51224001301","type":"NDC"}],"standard_charges":[{"gross_charge":94.97,"discounted_cash":33.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx51224001310","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"51224001310","type":"NDC"}],"standard_charges":[{"gross_charge":95.7,"discounted_cash":33.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51285036601","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"51285036601","type":"NDC"}],"standard_charges":[{"gross_charge":12.41,"discounted_cash":4.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51293080201","type":"CDM"},{"code":"51293080201","type":"NDC"}],"standard_charges":[{"gross_charge":3.54,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51293081101","type":"CDM"},{"code":"51293081101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AZELASTINE HCL OPHTH SOLN 0.05%","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx51525781506","type":"CDM"},{"code":"51525781506","type":"NDC"}],"standard_charges":[{"gross_charge":116.79,"discounted_cash":40.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE & TETRACAINE W/ EPINEPH KIT (COMPOUNDING KIT)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx51552134501","type":"CDM"},{"code":"51552134501","type":"NDC"}],"standard_charges":[{"gross_charge":95.05,"discounted_cash":33.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RIFAMPIN SUSP 25 MG/ML (COMPOUND KIT)","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx51552144403","type":"CDM"},{"code":"51552144403","type":"NDC"}],"standard_charges":[{"gross_charge":5.62,"discounted_cash":1.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VALSARTAN TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51660014190","type":"CDM"},{"code":"51660014190","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VALSARTAN TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51660014290","type":"CDM"},{"code":"51660014290","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51660020090","type":"CDM"},{"code":"51660020090","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CLOBETASOL PROPIONATE CREAM 0.05%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx51672125802","type":"CDM"},{"code":"51672125802","type":"NDC"}],"standard_charges":[{"gross_charge":27.49,"discounted_cash":9.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NYSTATIN-TRIAMCINOLONE CREAM 100000-0.1 UNIT/GM-%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672126301","type":"CDM"},{"code":"51672126301","type":"NDC"}],"standard_charges":[{"gross_charge":29.22,"discounted_cash":10.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE DENTAL PASTE 0.1%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx51672126705","type":"CDM"},{"code":"51672126705","type":"NDC"}],"standard_charges":[{"gross_charge":88.96,"discounted_cash":31.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE OINT 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672128401","type":"CDM"},{"code":"51672128401","type":"NDC"}],"standard_charges":[{"gross_charge":5.98,"discounted_cash":2.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NYSTATIN CREAM 100000 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx51672128902","type":"CDM"},{"code":"51672128902","type":"NDC"}],"standard_charges":[{"gross_charge":18.22,"discounted_cash":6.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLOBETASOL PROPIONATE SOLN 0.05%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx51672129302","type":"CDM"},{"code":"51672129302","type":"NDC"}],"standard_charges":[{"gross_charge":21.9,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TERCONAZOLE VAGINAL CREAM 0.4%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx51672130406","type":"CDM"},{"code":"51672130406","type":"NDC"}],"standard_charges":[{"gross_charge":31.38,"discounted_cash":10.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLOTRIMAZOLE W/ BETAMETHASONE LOTION 1-0.05%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx51672130803","type":"CDM"},{"code":"51672130803","type":"NDC"}],"standard_charges":[{"gross_charge":135.58,"discounted_cash":47.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MUPIROCIN CALCIUM CREAM 2%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672137001","type":"CDM"},{"code":"51672137001","type":"NDC"}],"standard_charges":[{"gross_charge":104.62,"discounted_cash":36.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CARBAMAZEPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672400501","type":"CDM"},{"code":"51672400501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLOMIPRAMINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672401106","type":"CDM"},{"code":"51672401106","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLOMIPRAMINE HCL CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672401205","type":"CDM"},{"code":"51672401205","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ACETAZOLAMIDE TAB 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672402201","type":"CDM"},{"code":"51672402201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETOCONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672402606","type":"CDM"},{"code":"51672402606","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARBAMAZEPINE CHEW TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672404101","type":"CDM"},{"code":"51672404101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMIODARONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672405506","type":"CDM"},{"code":"51672405506","type":"NDC"}],"standard_charges":[{"gross_charge":2.32,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARBAMAZEPINE TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672412301","type":"CDM"},{"code":"51672412301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARBAMAZEPINE TAB ER 12HR 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672412401","type":"CDM"},{"code":"51672412401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHENYTOIN CHEW TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672414601","type":"CDM"},{"code":"51672414601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TRANEXAMIC ACID-SODIUM CHLORIDE IV SOLN 1000 MG/100ML-0.7%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx51754010801","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"51754010801","type":"NDC"}],"standard_charges":[{"gross_charge":247.4,"discounted_cash":86.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx51754020301","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"51754020301","type":"NDC"}],"standard_charges":[{"gross_charge":314.74,"discounted_cash":110.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CAFFEINE CITRATE INJ 60 MG/3ML (10 MG/ML BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx51754050001","type":"CDM"},{"code":"J0706","type":"HCPCS"},{"code":"51754050001","type":"NDC"}],"standard_charges":[{"gross_charge":99.21,"discounted_cash":34.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CAFFEINE CITRATE ORAL SOLN 60 MG/3ML (10 MG/ML BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx51754050103","type":"CDM"},{"code":"51754050103","type":"NDC"}],"standard_charges":[{"gross_charge":14.09,"discounted_cash":4.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx51754500105","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"51754500105","type":"NDC"}],"standard_charges":[{"gross_charge":98.35,"discounted_cash":34.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx51754501101","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"51754501101","type":"NDC"}],"standard_charges":[{"gross_charge":246.28,"discounted_cash":86.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx51754501104","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"51754501104","type":"NDC"}],"standard_charges":[{"gross_charge":246.28,"discounted_cash":86.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BETAMETHASONE SOD PHOSPHATE & ACETATE INJ SUSP 6 (3-3) MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx51754506001","type":"CDM"},{"code":"J0702","type":"HCPCS"},{"code":"51754506001","type":"NDC"}],"standard_charges":[{"gross_charge":100.08,"discounted_cash":35.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POTASSIUM BICARBONATE-CITRIC ACID EFFER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51801001230","type":"CDM"},{"code":"51801001230","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POTASSIUM BICARBONATE-CITRIC ACID EFFER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51801001330","type":"CDM"},{"code":"51801001330","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51862024160","type":"CDM"},{"code":"51862024160","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL CAP ER 12HR 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51862032901","type":"CDM"},{"code":"51862032901","type":"NDC"}],"standard_charges":[{"gross_charge":3.67,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51862046001","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"51862046001","type":"NDC"}],"standard_charges":[{"gross_charge":4.26,"discounted_cash":1.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHADONE HCL INJ 10 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx51991000298","type":"CDM"},{"code":"J1230","type":"HCPCS"},{"code":"51991000298","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"RISPERIDONE TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991032006","type":"CDM"},{"code":"51991032006","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NEVIRAPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991033106","type":"CDM"},{"code":"51991033106","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 15 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991070890","type":"CDM"},{"code":"51991070890","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991070990","type":"CDM"},{"code":"51991070990","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"RIVASTIGMINE TARTRATE CAP 6 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991079606","type":"CDM"},{"code":"51991079606","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991081801","type":"CDM"},{"code":"51991081801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ENTECAVIR TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991089533","type":"CDM"},{"code":"51991089533","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FIDAXOMICIN TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52015008001","type":"CDM"},{"code":"52015008001","type":"NDC"}],"standard_charges":[{"gross_charge":175.38,"discounted_cash":61.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PYRIMETHAMINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52054033010","type":"CDM"},{"code":"52054033010","type":"NDC"}],"standard_charges":[{"gross_charge":19.03,"discounted_cash":6.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SILODOSIN CAP 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52544015130","type":"CDM"},{"code":"52544015130","type":"NDC"}],"standard_charges":[{"gross_charge":11.6,"discounted_cash":4.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROGESTERONE VAGINAL GEL 8%","drug_information":{"unit":1.125,"type":"GM"},"code_information":[{"code":"Rx52544028412","type":"CDM"},{"code":"52544028412","type":"NDC"}],"standard_charges":[{"gross_charge":24.31,"discounted_cash":8.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.075 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52544047254","type":"CDM"},{"code":"52544047254","type":"NDC"}],"standard_charges":[{"gross_charge":10.33,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52544047354","type":"CDM"},{"code":"52544047354","type":"NDC"}],"standard_charges":[{"gross_charge":10.56,"discounted_cash":3.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.025 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52544088454","type":"CDM"},{"code":"52544088454","type":"NDC"}],"standard_charges":[{"gross_charge":9.22,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IRON DEXTRAN INJ 50 MG/ML (ELEMENTAL IRON)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx52544093107","type":"CDM"},{"code":"J1750","type":"HCPCS"},{"code":"52544093107","type":"NDC"}],"standard_charges":[{"gross_charge":138.32,"discounted_cash":48.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx52565000950","type":"CDM"},{"code":"52565000950","type":"NDC"}],"standard_charges":[{"gross_charge":74.62,"discounted_cash":26.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUOCINOLONE ACETONIDE OINT 0.025%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx52565001315","type":"CDM"},{"code":"52565001315","type":"NDC"}],"standard_charges":[{"gross_charge":40.52,"discounted_cash":14.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB ER 24HR 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52817016060","type":"CDM"},{"code":"52817016060","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52817026010","type":"CDM"},{"code":"52817026010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SILDENAFIL CITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52817029590","type":"CDM"},{"code":"52817029590","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52817032010","type":"CDM"},{"code":"52817032010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BACLOFEN TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52817032110","type":"CDM"},{"code":"52817032110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52817039210","type":"CDM"},{"code":"52817039210","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ACETIC ACID OTIC SOLN 2%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx52817081615","type":"CDM"},{"code":"52817081615","type":"NDC"}],"standard_charges":[{"gross_charge":21.03,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOCARNITINE ORAL SOLN 1 GM/10ML (10%)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx52817083004","type":"CDM"},{"code":"52817083004","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MICROFIBRILLAR COLLAGEN HEMOSTAT PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53276101008","type":"CDM"},{"code":"53276101008","type":"NDC"}],"standard_charges":[{"gross_charge":88.59,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MICROFIBRILLAR COLLAGEN HEMOSTAT PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53276101009","type":"CDM"},{"code":"53276101009","type":"NDC"}],"standard_charges":[{"gross_charge":195.75,"discounted_cash":68.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746010201","type":"CDM"},{"code":"53746010201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746010301","type":"CDM"},{"code":"53746010301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746046501","type":"CDM"},{"code":"53746046501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746064201","type":"CDM"},{"code":"53746064201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GUANFACINE HCL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746071101","type":"CDM"},{"code":"53746071101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARBAMAZEPINE CAP ER 12HR 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54092017212","type":"CDM"},{"code":"54092017212","type":"NDC"}],"standard_charges":[{"gross_charge":2.43,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LANTHANUM CARBONATE CHEW TAB 500 MG (ELEMENTAL)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54092025245","type":"CDM"},{"code":"54092025245","type":"NDC"}],"standard_charges":[{"gross_charge":16.69,"discounted_cash":5.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx54288010301","type":"CDM"},{"code":"54288010301","type":"NDC"}],"standard_charges":[{"gross_charge":94.87,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 65 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx54288013601","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"54288013601","type":"NDC"}],"standard_charges":[{"gross_charge":257.67,"discounted_cash":90.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 130 MG/ML","drug_information":{"unit":0.3846153846153846154,"type":"ML"},"code_information":[{"code":"Rx54288013701","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"54288013701","type":"NDC"}],"standard_charges":[{"gross_charge":265.34,"discounted_cash":92.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHYLENE BLUE IV SOLN PREFILLED SYRINGE 20 MG/2ML (1%)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx54288015905","type":"CDM"},{"code":"Q9968","type":"HCPCS"},{"code":"54288015905","type":"NDC"}],"standard_charges":[{"gross_charge":307.97,"discounted_cash":107.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCORTISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54505033105","type":"CDM"},{"code":"54505033105","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PEDIATRIC MULTIPLE VITAMINS IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx54643564700","type":"CDM"},{"code":"54643564700","type":"NDC"}],"standard_charges":[{"gross_charge":1508.64,"discounted_cash":528.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROXYZINE HCL SYRUP 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx54838050280","type":"CDM"},{"code":"54838050280","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYOSCYAMINE SULFATE SOLN 0.125 MG/ML","drug_information":{"unit":0.125,"type":"ML"},"code_information":[{"code":"Rx54838050615","type":"CDM"},{"code":"54838050615","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXEPIN HCL CONC 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx54838051240","type":"CDM"},{"code":"54838051240","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUOXETINE HCL SOLUTION 20 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx54838052340","type":"CDM"},{"code":"54838052340","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx54838054880","type":"CDM"},{"code":"54838054880","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111012390","type":"CDM"},{"code":"55111012390","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111012701","type":"CDM"},{"code":"55111012701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111014571","type":"CDM"},{"code":"55111014571","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NATEGLINIDE TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111032990","type":"CDM"},{"code":"55111032990","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE FOR IV SOLN 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111065237","type":"CDM"},{"code":"J0583","type":"HCPCS"},{"code":"55111065237","type":"NDC"}],"standard_charges":[{"gross_charge":497.89,"discounted_cash":174.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111067131","type":"CDM"},{"code":"55111067131","type":"NDC"}],"standard_charges":[{"gross_charge":23.95,"discounted_cash":8.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 2.5 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55111067802","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111067802","type":"NDC"}],"standard_charges":[{"gross_charge":100.54,"discounted_cash":35.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 5 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx55111067902","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111067902","type":"NDC"}],"standard_charges":[{"gross_charge":204.12,"discounted_cash":71.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 7.5 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55111068002","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111068002","type":"NDC"}],"standard_charges":[{"gross_charge":608.27,"discounted_cash":212.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111073130","type":"CDM"},{"code":"55111073130","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VALSARTAN TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111073290","type":"CDM"},{"code":"55111073290","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011720","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"55150011720","type":"NDC"}],"standard_charges":[{"gross_charge":96.6,"discounted_cash":33.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OXACILLIN SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150012715","type":"CDM"},{"code":"J2700","type":"HCPCS"},{"code":"55150012715","type":"NDC"}],"standard_charges":[{"gross_charge":96.93,"discounted_cash":33.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LEVOFLOXACIN IV SOLN 25 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx55150015620","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"55150015620","type":"NDC"}],"standard_charges":[{"gross_charge":97.97,"discounted_cash":34.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150016102","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"55150016102","type":"NDC"}],"standard_charges":[{"gross_charge":93.91,"discounted_cash":32.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150016205","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"55150016205","type":"NDC"}],"standard_charges":[{"gross_charge":93.45,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150016330","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"55150016330","type":"NDC"}],"standard_charges":[{"gross_charge":93.29,"discounted_cash":32.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150016505","type":"CDM"},{"code":"55150016505","type":"NDC"}],"standard_charges":[{"gross_charge":93.42,"discounted_cash":32.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ESOMEPRAZOLE SODIUM FOR INTRAVENOUS SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150018505","type":"CDM"},{"code":"J1370","type":"HCPCS"},{"code":"55150018505","type":"NDC"}],"standard_charges":[{"gross_charge":96.36,"discounted_cash":33.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150019830","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"55150019830","type":"NDC"}],"standard_charges":[{"gross_charge":93.9,"discounted_cash":32.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150020200","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"55150020200","type":"NDC"}],"standard_charges":[{"gross_charge":95.74,"discounted_cash":33.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150023501","type":"CDM"},{"code":"55150023501","type":"NDC"}],"standard_charges":[{"gross_charge":96.59,"discounted_cash":33.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150023510","type":"CDM"},{"code":"55150023510","type":"NDC"}],"standard_charges":[{"gross_charge":95.47,"discounted_cash":33.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150025410","type":"CDM"},{"code":"55150025410","type":"NDC"}],"standard_charges":[{"gross_charge":93.34,"discounted_cash":32.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150030401","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"55150030401","type":"NDC"}],"standard_charges":[{"gross_charge":3.4,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx55150030425","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"55150030425","type":"NDC"}],"standard_charges":[{"gross_charge":93.52,"discounted_cash":32.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150030425","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"55150030425","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx55150032710","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"55150032710","type":"NDC"}],"standard_charges":[{"gross_charge":93.91,"discounted_cash":32.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMPHOTERICIN B LIPOSOME IV FOR SUSP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150036501","type":"CDM"},{"code":"J0289","type":"HCPCS"},{"code":"55150036501","type":"NDC"}],"standard_charges":[{"gross_charge":1078.22,"discounted_cash":377.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55154358004","type":"CDM"},{"code":"55154358004","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55154358007","type":"CDM"},{"code":"55154358007","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55154358107","type":"CDM"},{"code":"55154358107","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PAROXETINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55154667307","type":"CDM"},{"code":"55154667307","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DACTINOMYCIN FOR INJ 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55292081155","type":"CDM"},{"code":"J9120","type":"HCPCS"},{"code":"55292081155","type":"NDC"}],"standard_charges":[{"gross_charge":23264.05,"discounted_cash":8142.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMIKACIN SULFATE INJ 1 GM/4ML (250 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx55390022604","type":"CDM"},{"code":"J0278","type":"HCPCS"},{"code":"55390022604","type":"NDC"}],"standard_charges":[{"gross_charge":135.38,"discounted_cash":47.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXORUBICIN HCL FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55390023301","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"55390023301","type":"NDC"}],"standard_charges":[{"gross_charge":637.4,"discounted_cash":223.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMIFOSTINE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55390030803","type":"CDM"},{"code":"J0207","type":"HCPCS"},{"code":"55390030803","type":"NDC"}],"standard_charges":[{"gross_charge":4885.97,"discounted_cash":1710.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55390031010","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"55390031010","type":"NDC"}],"standard_charges":[{"gross_charge":94.14,"discounted_cash":32.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx55390056530","type":"CDM"},{"code":"55390056530","type":"NDC"}],"standard_charges":[{"gross_charge":100.47,"discounted_cash":35.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DARBEPOETIN ALFA SOLN PREFILLED SYRINGE 300 MCG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55513011101","type":"CDM"},{"code":"J0881","type":"HCPCS"},{"code":"55513011101","type":"NDC"}],"standard_charges":[{"gross_charge":23813.66,"discounted_cash":8334.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DENOSUMAB INJ SOLN PREFILLED SYRINGE 60 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55513071001","type":"CDM"},{"code":"J0897","type":"HCPCS"},{"code":"55513071001","type":"NDC"}],"standard_charges":[{"gross_charge":19253.02,"discounted_cash":6738.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PANITUMUMAB IV SOLN 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55513095401","type":"CDM"},{"code":"J9303","type":"HCPCS"},{"code":"55513095401","type":"NDC"}],"standard_charges":[{"gross_charge":17204.66,"discounted_cash":6021.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PANITUMUMAB IV SOLN 400 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx55513095601","type":"CDM"},{"code":"J9303","type":"HCPCS"},{"code":"55513095601","type":"NDC"}],"standard_charges":[{"gross_charge":33207.9,"discounted_cash":11622.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237006290","type":"CDM"},{"code":"57237006290","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALFUZOSIN HCL TAB ER 24HR 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237011490","type":"CDM"},{"code":"57237011490","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237016890","type":"CDM"},{"code":"57237016890","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 25 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237017201","type":"CDM"},{"code":"57237017201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 25 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57664039288","type":"CDM"},{"code":"57664039288","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx57664068331","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"57664068331","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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":0.01,"discounted_cash":0.0035,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"},{"gross_charge":11986.68,"discounted_cash":4195.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TECLISTAMAB-CQYV SUBCUTANEOUS SOLN 30 MG/3ML (10 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx57894044901","type":"CDM"},{"code":"J9380","type":"HCPCS"},{"code":"57894044901","type":"NDC"}],"standard_charges":[{"gross_charge":18333.65,"discounted_cash":6416.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DIPH, ACELLULAR PERT & TET TOX INJ 25 LF-58 MCG-10 LF/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160081052","type":"CDM"},{"code":"90700","type":"HCPCS"},{"code":"58160081052","type":"NDC"}],"standard_charges":[{"gross_charge":238.87,"discounted_cash":83.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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":"Rx58160082043","type":"CDM"},{"code":"90744","type":"HCPCS"},{"code":"58160082043","type":"NDC"}],"standard_charges":[{"gross_charge":144.48,"discounted_cash":50.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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":"Rx58160084243","type":"CDM"},{"code":"90715","type":"HCPCS"},{"code":"58160084243","type":"NDC"}],"standard_charges":[{"gross_charge":449.75,"discounted_cash":157.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SEVELAMER HCL TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58468002001","type":"CDM"},{"code":"58468002001","type":"NDC"}],"standard_charges":[{"gross_charge":4.91,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYLAN G-F 20 INTRA-ARTICULAR SOLN PREFILLED SYR 48 MG/6ML","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx58468009003","type":"CDM"},{"code":"J7325","type":"HCPCS"},{"code":"58468009003","type":"NDC"}],"standard_charges":[{"gross_charge":7030.26,"discounted_cash":2460.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SEVELAMER CARBONATE TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58468013001","type":"CDM"},{"code":"58468013001","type":"NDC"}],"standard_charges":[{"gross_charge":8.16,"discounted_cash":2.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SEVELAMER CARBONATE PACKET 0.8 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58468013201","type":"CDM"},{"code":"58468013201","type":"NDC"}],"standard_charges":[{"gross_charge":24.81,"discounted_cash":8.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58657061190","type":"CDM"},{"code":"58657061190","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 4 MG/ML","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx59011044410","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"59011044410","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59148000713","type":"CDM"},{"code":"59148000713","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":9.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59148000813","type":"CDM"},{"code":"59148000813","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":9.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59148000835","type":"CDM"},{"code":"59148000835","type":"NDC"}],"standard_charges":[{"gross_charge":41.74,"discounted_cash":14.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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":"Rx59212042304","type":"CDM"},{"code":"59212042304","type":"NDC"}],"standard_charges":[{"gross_charge":27.57,"discounted_cash":9.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BECLOMETHASONE DIPROP HFA BREATH ACT INH AER 40 MCG/ACT","drug_information":{"unit":10.6,"type":"GM"},"code_information":[{"code":"Rx59310030240","type":"CDM"},{"code":"59310030240","type":"NDC"}],"standard_charges":[{"gross_charge":301.03,"discounted_cash":105.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":8.5,"type":"GM"},"code_information":[{"code":"Rx59310057922","type":"CDM"},{"code":"59310057922","type":"NDC"}],"standard_charges":[{"gross_charge":101.57,"discounted_cash":35.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FERUMOXYTOL INJ 510 MG/17ML (30 MG/ML) (ELEMENTAL FE)","drug_information":{"unit":17.0,"type":"ML"},"code_information":[{"code":"Rx59338077501","type":"CDM"},{"code":"Q0138","type":"HCPCS"},{"code":"59338077501","type":"NDC"}],"standard_charges":[{"gross_charge":1511.01,"discounted_cash":528.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AZACITIDINE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59572010201","type":"CDM"},{"code":"J9025","type":"HCPCS"},{"code":"59572010201","type":"NDC"}],"standard_charges":[{"gross_charge":6100.44,"discounted_cash":2135.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CANDIDA ALBICANS SKIN TEST ANTIGEN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx59584013801","type":"CDM"},{"code":"86485","type":"HCPCS"},{"code":"59584013801","type":"NDC"}],"standard_charges":[{"gross_charge":330.56,"discounted_cash":115.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NITROFURANTOIN SUSP 25 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx59630045008","type":"CDM"},{"code":"59630045008","type":"NDC"}],"standard_charges":[{"gross_charge":55.54,"discounted_cash":19.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DOXEPIN HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651017301","type":"CDM"},{"code":"59651017301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AZELASTINE HCL NASAL SPRAY 0.1% (137 MCG/SPRAY)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx59651021430","type":"CDM"},{"code":"59651021430","type":"NDC"}],"standard_charges":[{"gross_charge":8.82,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROPAFENONE HCL TAB 225 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651025701","type":"CDM"},{"code":"59651025701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ZONISAMIDE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651038001","type":"CDM"},{"code":"59651038001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLIPIZIDE TAB ER 24HR 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651078030","type":"CDM"},{"code":"59651078030","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EPOETIN ALFA INJ 2000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx59676030200","type":"CDM"},{"code":"J0885","type":"HCPCS"},{"code":"59676030200","type":"NDC"}],"standard_charges":[{"gross_charge":543.87,"discounted_cash":190.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EPOETIN ALFA INJ 3000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx59676030300","type":"CDM"},{"code":"J0885","type":"HCPCS"},{"code":"59676030300","type":"NDC"}],"standard_charges":[{"gross_charge":815.72,"discounted_cash":285.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL SUSP (FOR IV INFUSION) 2 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx59676096001","type":"CDM"},{"code":"Q2050","type":"HCPCS"},{"code":"59676096001","type":"NDC"}],"standard_charges":[{"gross_charge":12081.85,"discounted_cash":4228.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCORTISONE ACETATE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59741030112","type":"CDM"},{"code":"59741030112","type":"NDC"}],"standard_charges":[{"gross_charge":3.93,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHYLPREDNISOLONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746000106","type":"CDM"},{"code":"J7509","type":"HCPCS"},{"code":"59746000106","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746032430","type":"CDM"},{"code":"59746032430","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TERAZOSIN HCL CAP 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746038506","type":"CDM"},{"code":"59746038506","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN PALMITATE HCL FOR SOLN 75 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx59762001601","type":"CDM"},{"code":"59762001601","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHYLPREDNISOLONE TAB 16 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762005001","type":"CDM"},{"code":"J7509","type":"HCPCS"},{"code":"59762005001","type":"NDC"}],"standard_charges":[{"gross_charge":3.39,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762005501","type":"CDM"},{"code":"59762005501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCORTISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762007501","type":"CDM"},{"code":"59762007501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SULFASALAZINE TAB DELAYED RELEASE 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762010405","type":"CDM"},{"code":"59762010405","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MESALAMINE CAP DR 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762011701","type":"CDM"},{"code":"59762011701","type":"NDC"}],"standard_charges":[{"gross_charge":3.2,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762018102","type":"CDM"},{"code":"59762018102","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 150 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762018201","type":"CDM"},{"code":"59762018201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE ORALLY DISINTEGRATING TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762025201","type":"CDM"},{"code":"59762025201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"COLESTIPOL HCL GRANULE PACKETS 5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762026001","type":"CDM"},{"code":"59762026001","type":"NDC"}],"standard_charges":[{"gross_charge":2.82,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"COLESTIPOL HCL TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762045001","type":"CDM"},{"code":"59762045001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DICLOFENAC EPOLAMINE PATCH 1.3%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762070702","type":"CDM"},{"code":"59762070702","type":"NDC"}],"standard_charges":[{"gross_charge":7.59,"discounted_cash":2.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SIROLIMUS TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762100101","type":"CDM"},{"code":"J7520","type":"HCPCS"},{"code":"59762100101","type":"NDC"}],"standard_charges":[{"gross_charge":6.07,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762106101","type":"CDM"},{"code":"59762106101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"EPLERENONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762171001","type":"CDM"},{"code":"59762171001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762306002","type":"CDM"},{"code":"59762306002","type":"NDC"}],"standard_charges":[{"gross_charge":2.97,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762306003","type":"CDM"},{"code":"59762306003","type":"NDC"}],"standard_charges":[{"gross_charge":3.11,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AZITHROMYCIN FOR SUSP 200 MG/5ML","drug_information":{"unit":6.25,"type":"ML"},"code_information":[{"code":"Rx59762314001","type":"CDM"},{"code":"59762314001","type":"NDC"}],"standard_charges":[{"gross_charge":5.81,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762332801","type":"CDM"},{"code":"59762332801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TRIAZOLAM TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762371704","type":"CDM"},{"code":"59762371704","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762374101","type":"CDM"},{"code":"59762374101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHYLPREDNISOLONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762444003","type":"CDM"},{"code":"J7509","type":"HCPCS"},{"code":"59762444003","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SULFASALAZINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762500001","type":"CDM"},{"code":"59762500001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SULFASALAZINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762500006","type":"CDM"},{"code":"59762500006","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MISOPROSTOL TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762500701","type":"CDM"},{"code":"59762500701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MISOPROSTOL TAB 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762500802","type":"CDM"},{"code":"59762500802","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE VAGINAL CREAM 2%","drug_information":{"unit":40.0,"type":"GM"},"code_information":[{"code":"Rx59762500901","type":"CDM"},{"code":"59762500901","type":"NDC"}],"standard_charges":[{"gross_charge":119.88,"discounted_cash":41.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762501801","type":"CDM"},{"code":"59762501801","type":"NDC"}],"standard_charges":[{"gross_charge":3.01,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN ORAL SOLN 250 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx59762502501","type":"CDM"},{"code":"59762502501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE FOR SUSP 10 MG/ML","drug_information":{"unit":35.0,"type":"ML"},"code_information":[{"code":"Rx59762502901","type":"CDM"},{"code":"59762502901","type":"NDC"}],"standard_charges":[{"gross_charge":22.62,"discounted_cash":7.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUCONAZOLE FOR SUSP 40 MG/ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx59762503001","type":"CDM"},{"code":"59762503001","type":"NDC"}],"standard_charges":[{"gross_charge":2.93,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762669008","type":"CDM"},{"code":"59762669008","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE FOR SUSP 200 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60219150301","type":"CDM"},{"code":"60219150301","type":"NDC"}],"standard_charges":[{"gross_charge":9.06,"discounted_cash":3.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"B-COMPLEX W/ C & FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60258016101","type":"CDM"},{"code":"60258016101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYOSCYAMINE SULFATE SOLN 0.125 MG/ML","drug_information":{"unit":0.125,"type":"ML"},"code_information":[{"code":"Rx60258080215","type":"CDM"},{"code":"60258080215","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM NITRITE INJ 30 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60267031110","type":"CDM"},{"code":"60267031110","type":"NDC"}],"standard_charges":[{"gross_charge":317.29,"discounted_cash":111.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60429016460","type":"CDM"},{"code":"60429016460","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LAMIVUDINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60429035360","type":"CDM"},{"code":"60429035360","type":"NDC"}],"standard_charges":[{"gross_charge":7.33,"discounted_cash":2.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOPIRAMATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60429076960","type":"CDM"},{"code":"60429076960","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUOCINONIDE OINT 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx60429090715","type":"CDM"},{"code":"60429090715","type":"NDC"}],"standard_charges":[{"gross_charge":2.09,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx60432046550","type":"CDM"},{"code":"60432046550","type":"NDC"}],"standard_charges":[{"gross_charge":10.72,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE LOTION 0.1%","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx60432056160","type":"CDM"},{"code":"60432056160","type":"NDC"}],"standard_charges":[{"gross_charge":19.44,"discounted_cash":6.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505011200","type":"CDM"},{"code":"60505011200","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYCLOSPORINE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505013300","type":"CDM"},{"code":"J7515","type":"HCPCS"},{"code":"60505013300","type":"NDC"}],"standard_charges":[{"gross_charge":2.8,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUPROPION HCL TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505015801","type":"CDM"},{"code":"60505015801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MIRTAZAPINE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505024701","type":"CDM"},{"code":"60505024701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OFLOXACIN OTIC SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60505036301","type":"CDM"},{"code":"60505036301","type":"NDC"}],"standard_charges":[{"gross_charge":24.6,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AZELASTINE HCL OPHTH SOLN 0.05%","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx60505057804","type":"CDM"},{"code":"60505057804","type":"NDC"}],"standard_charges":[{"gross_charge":7.36,"discounted_cash":2.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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":"Rx60505068804","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"60505068804","type":"NDC"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505076005","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"60505076005","type":"NDC"}],"standard_charges":[{"gross_charge":130.54,"discounted_cash":45.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DESMOPRESSIN ACETATE NASAL SPRAY SOLN 0.01%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60505081500","type":"CDM"},{"code":"60505081500","type":"NDC"}],"standard_charges":[{"gross_charge":70.23,"discounted_cash":24.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LEFLUNOMIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505250201","type":"CDM"},{"code":"60505250201","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":1.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CILOSTAZOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505252201","type":"CDM"},{"code":"60505252201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505255201","type":"CDM"},{"code":"60505255201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TRAZODONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505265300","type":"CDM"},{"code":"60505265300","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TRIAMTERENE & HYDROCHLOROTHIAZIDE TAB 37.5-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505265601","type":"CDM"},{"code":"60505265601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALFUZOSIN HCL TAB ER 24HR 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505285001","type":"CDM"},{"code":"60505285001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505307503","type":"CDM"},{"code":"60505307503","type":"NDC"}],"standard_charges":[{"gross_charge":2.04,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505377809","type":"CDM"},{"code":"60505377809","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DUTASTERIDE CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505387703","type":"CDM"},{"code":"60505387703","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE FOR IV SOLN 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505610104","type":"CDM"},{"code":"J0583","type":"HCPCS"},{"code":"60505610104","type":"NDC"}],"standard_charges":[{"gross_charge":1406.91,"discounted_cash":492.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505612006","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"60505612006","type":"NDC"}],"standard_charges":[{"gross_charge":803.85,"discounted_cash":281.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614200","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"60505614200","type":"NDC"}],"standard_charges":[{"gross_charge":94.2,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFEPIME HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614600","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614600","type":"NDC"}],"standard_charges":[{"gross_charge":95.51,"discounted_cash":33.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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":"Rx60505615604","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"60505615604","type":"NDC"}],"standard_charges":[{"gross_charge":95.82,"discounted_cash":33.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505619604","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"gross_charge":207.2,"discounted_cash":72.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEVIMELINE HCL CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687011795","type":"CDM"},{"code":"60687011795","type":"NDC"}],"standard_charges":[{"gross_charge":3.85,"discounted_cash":1.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MELOXICAM TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687019901","type":"CDM"},{"code":"60687019901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GEMFIBROZIL TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687022401","type":"CDM"},{"code":"60687022401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SERTRALINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687023101","type":"CDM"},{"code":"60687023101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60687024940","type":"CDM"},{"code":"60687024940","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":1.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687036911","type":"CDM"},{"code":"60687036911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx60687039583","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"60687039583","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687048401","type":"CDM"},{"code":"60687048401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059011","type":"CDM"},{"code":"60687059011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OXCARBAZEPINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687071101","type":"CDM"},{"code":"60687071101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXCARBAZEPINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687071111","type":"CDM"},{"code":"60687071111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PREDNISONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687085401","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687085401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687088601","type":"CDM"},{"code":"60687088601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687088611","type":"CDM"},{"code":"60687088611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GENTAMICIN SULFATE OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60758018805","type":"CDM"},{"code":"60758018805","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60758080205","type":"CDM"},{"code":"60758080205","type":"NDC"}],"standard_charges":[{"gross_charge":4.33,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"THROMBIN FOR SOLN 5000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60793021505","type":"CDM"},{"code":"60793021505","type":"NDC"}],"standard_charges":[{"gross_charge":79.29,"discounted_cash":27.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PENICILLIN G BENZATHINE & PROCAINE INJ 900000-300000 UNT/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx60793060202","type":"CDM"},{"code":"J05858","type":"HCPCS"},{"code":"60793060202","type":"NDC"}],"standard_charges":[{"gross_charge":1424.41,"discounted_cash":498.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DICLOFENAC SODIUM OPHTH SOLN 0.1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314001405","type":"CDM"},{"code":"61314001405","type":"NDC"}],"standard_charges":[{"gross_charge":19.53,"discounted_cash":6.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DORZOLAMIDE HCL OPHTH SOLN 2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61314001910","type":"CDM"},{"code":"61314001910","type":"NDC"}],"standard_charges":[{"gross_charge":14.98,"discounted_cash":5.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61314012610","type":"CDM"},{"code":"61314012610","type":"NDC"}],"standard_charges":[{"gross_charge":78.12,"discounted_cash":27.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314022605","type":"CDM"},{"code":"61314022605","type":"NDC"}],"standard_charges":[{"gross_charge":4.89,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.25%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314022615","type":"CDM"},{"code":"61314022615","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314022715","type":"CDM"},{"code":"61314022715","type":"NDC"}],"standard_charges":[{"gross_charge":15.09,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BETAXOLOL HCL OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314024501","type":"CDM"},{"code":"61314024501","type":"NDC"}],"standard_charges":[{"gross_charge":70.08,"discounted_cash":24.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE OPHTH SOLN 0.1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314029405","type":"CDM"},{"code":"61314029405","type":"NDC"}],"standard_charges":[{"gross_charge":23.59,"discounted_cash":8.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314030301","type":"CDM"},{"code":"61314030301","type":"NDC"}],"standard_charges":[{"gross_charge":21.9,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AZELASTINE HCL OPHTH SOLN 0.05%","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx61314030802","type":"CDM"},{"code":"61314030802","type":"NDC"}],"standard_charges":[{"gross_charge":48.82,"discounted_cash":17.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx61314039601","type":"CDM"},{"code":"61314039601","type":"NDC"}],"standard_charges":[{"gross_charge":4.99,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314039603","type":"CDM"},{"code":"61314039603","type":"NDC"}],"standard_charges":[{"gross_charge":20.02,"discounted_cash":7.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LATANOPROST OPHTH SOLN 0.005%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx61314054703","type":"CDM"},{"code":"61314054703","type":"NDC"}],"standard_charges":[{"gross_charge":19.59,"discounted_cash":6.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POLYMYXIN B-TRIMETHOPRIM OPHTH SOLN 10000 UNIT/ML-0.1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61314062810","type":"CDM"},{"code":"61314062810","type":"NDC"}],"standard_charges":[{"gross_charge":9.24,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PREDNISOLONE ACETATE OPHTH SUSP 1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61314063710","type":"CDM"},{"code":"61314063710","type":"NDC"}],"standard_charges":[{"gross_charge":73.18,"discounted_cash":25.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-HC OTIC SOLN 1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61314064610","type":"CDM"},{"code":"61314064610","type":"NDC"}],"standard_charges":[{"gross_charge":119.56,"discounted_cash":41.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CIPROFLOXACIN HCL OPHTH SOLN 0.3% (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314065605","type":"CDM"},{"code":"61314065605","type":"NDC"}],"standard_charges":[{"gross_charge":19.53,"discounted_cash":6.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GATIFLOXACIN OPHTH SOLN 0.5%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx61314067225","type":"CDM"},{"code":"61314067225","type":"NDC"}],"standard_charges":[{"gross_charge":56.89,"discounted_cash":19.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SULFACETAMIDE SODIUM OPHTH SOLN 10%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314070101","type":"CDM"},{"code":"61314070101","type":"NDC"}],"standard_charges":[{"gross_charge":61.67,"discounted_cash":21.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ACYCLOVIR CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61442011101","type":"CDM"},{"code":"61442011101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MELOXICAM TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61442012601","type":"CDM"},{"code":"61442012601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":400.0,"type":"GM"},"code_information":[{"code":"Rx61570013140","type":"CDM"},{"code":"61570013140","type":"NDC"}],"standard_charges":[{"gross_charge":62.4,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PACLITAXEL IV CONC 30 MG/5ML (6 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61703034209","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"61703034209","type":"NDC"}],"standard_charges":[{"gross_charge":288.3,"discounted_cash":100.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"EPIRUBICIN HCL IV SOLN 50 MG/25ML (2 MG/ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx61703035993","type":"CDM"},{"code":"J9178","type":"HCPCS"},{"code":"61703035993","type":"NDC"}],"standard_charges":[{"gross_charge":527.23,"discounted_cash":184.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 100 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx61703036322","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"61703036322","type":"NDC"}],"standard_charges":[{"gross_charge":263.03,"discounted_cash":92.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ISONIAZID TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61748001330","type":"CDM"},{"code":"61748001330","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"EMTRICITABINE-TENOFOVIR DISOPROXIL FUMARATE TAB 200-300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61958070101","type":"CDM"},{"code":"61958070101","type":"NDC"}],"standard_charges":[{"gross_charge":84.45,"discounted_cash":29.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ELVITEGRAV-COBIC-EMTRICITAB-TENOFOV AF TAB 150-150-200-10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61958190101","type":"CDM"},{"code":"61958190101","type":"NDC"}],"standard_charges":[{"gross_charge":193.28,"discounted_cash":67.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61990061102","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"61990061102","type":"NDC"}],"standard_charges":[{"gross_charge":95.86,"discounted_cash":33.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHYLDOPA TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62135032190","type":"CDM"},{"code":"62135032190","type":"NDC"}],"standard_charges":[{"gross_charge":10.31,"discounted_cash":3.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62175027037","type":"CDM"},{"code":"62175027037","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TALC INTRAPLEURAL POWDER 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62327022242","type":"CDM"},{"code":"62327022242","type":"NDC"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":392.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TALC INTRAPLEURAL POWDER 3 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62327033303","type":"CDM"},{"code":"62327033303","type":"NDC"}],"standard_charges":[{"gross_charge":1400.0,"discounted_cash":490.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VILAZODONE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62332023330","type":"CDM"},{"code":"62332023330","type":"NDC"}],"standard_charges":[{"gross_charge":7.32,"discounted_cash":2.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMANTADINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62332024631","type":"CDM"},{"code":"62332024631","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TOBRAMYCIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx62332051805","type":"CDM"},{"code":"62332051805","type":"NDC"}],"standard_charges":[{"gross_charge":10.53,"discounted_cash":3.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXEPIN HCL CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62332064531","type":"CDM"},{"code":"62332064531","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OPIUM TINCTURE 1% (10 MG/ML) (MORPHINE EQUIV)","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx62559015304","type":"CDM"},{"code":"62559015304","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PYRIDOSTIGMINE BROMIDE TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559047001","type":"CDM"},{"code":"62559047001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEMECLOCYCLINE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584015901","type":"CDM"},{"code":"62584015901","type":"NDC"}],"standard_charges":[{"gross_charge":8.44,"discounted_cash":2.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEMECLOCYCLINE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584015911","type":"CDM"},{"code":"62584015911","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584025911","type":"CDM"},{"code":"62584025911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METFORMIN HCL TAB 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584045211","type":"CDM"},{"code":"62584045211","type":"NDC"}],"standard_charges":[{"gross_charge":2.28,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ATENOLOL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584046711","type":"CDM"},{"code":"62584046711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584065711","type":"CDM"},{"code":"62584065711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584073311","type":"CDM"},{"code":"62584073311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584073411","type":"CDM"},{"code":"62584073411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584073911","type":"CDM"},{"code":"62584073911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584097611","type":"CDM"},{"code":"62584097611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584098401","type":"CDM"},{"code":"62584098401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584098801","type":"CDM"},{"code":"62584098801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584099401","type":"CDM"},{"code":"62584099401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756013902","type":"CDM"},{"code":"62756013902","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RIVASTIGMINE TARTRATE CAP 1.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756014586","type":"CDM"},{"code":"62756014586","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756020201","type":"CDM"},{"code":"62756020201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LOTEPREDNOL ETABONATE OPHTH SUSP 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx62756023290","type":"CDM"},{"code":"62756023290","type":"NDC"}],"standard_charges":[{"gross_charge":261.97,"discounted_cash":91.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 50 MCG/ML (0.05 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx62756034844","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"62756034844","type":"NDC"}],"standard_charges":[{"gross_charge":98.51,"discounted_cash":34.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756035664","type":"CDM"},{"code":"Q0162","type":"HCPCS"},{"code":"62756035664","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756043283","type":"CDM"},{"code":"62756043283","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756051244","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"62756051244","type":"NDC"}],"standard_charges":[{"gross_charge":95.54,"discounted_cash":33.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DESMOPRESSIN ACETATE INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx62756052940","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"62756052940","type":"NDC"}],"standard_charges":[{"gross_charge":98.29,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756075160","type":"CDM"},{"code":"62756075160","type":"NDC"}],"standard_charges":[{"gross_charge":1.94,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756075164","type":"CDM"},{"code":"62756075164","type":"NDC"}],"standard_charges":[{"gross_charge":1.94,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756079688","type":"CDM"},{"code":"62756079688","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756079888","type":"CDM"},{"code":"62756079888","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DECITABINE FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62856060001","type":"CDM"},{"code":"J0894","type":"HCPCS"},{"code":"62856060001","type":"NDC"}],"standard_charges":[{"gross_charge":17725.95,"discounted_cash":6204.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BORTEZOMIB FOR INJ 3.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63020004901","type":"CDM"},{"code":"J9041","type":"HCPCS"},{"code":"63020004901","type":"NDC"}],"standard_charges":[{"gross_charge":16531.04,"discounted_cash":5785.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63304009719","type":"CDM"},{"code":"63304009719","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63304029601","type":"CDM"},{"code":"63304029601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63304033701","type":"CDM"},{"code":"63304033701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEVIMELINE HCL CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63304047901","type":"CDM"},{"code":"63304047901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63304069201","type":"CDM"},{"code":"63304069201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63304069301","type":"CDM"},{"code":"63304069301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63304098701","type":"CDM"},{"code":"63304098701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001201","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"63323001201","type":"NDC"}],"standard_charges":[{"gross_charge":93.85,"discounted_cash":32.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001302","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"63323001302","type":"NDC"}],"standard_charges":[{"gross_charge":94.8,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323004401","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"63323004401","type":"NDC"}],"standard_charges":[{"gross_charge":94.44,"discounted_cash":33.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323006402","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323006402","type":"NDC"}],"standard_charges":[{"gross_charge":94.72,"discounted_cash":33.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323006420","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323006420","type":"NDC"}],"standard_charges":[{"gross_charge":93.57,"discounted_cash":32.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CISPLATIN INJ 50 MG/50ML (1 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323010351","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"63323010351","type":"NDC"}],"standard_charges":[{"gross_charge":285.41,"discounted_cash":99.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 2.5 GM/50ML (50 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323011751","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"63323011751","type":"NDC"}],"standard_charges":[{"gross_charge":288.1,"discounted_cash":100.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYTARABINE INJ PF 100 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323012020","type":"CDM"},{"code":"J9100","type":"HCPCS"},{"code":"63323012020","type":"NDC"}],"standard_charges":[{"gross_charge":236.82,"discounted_cash":82.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DACARBAZINE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323012710","type":"CDM"},{"code":"J9130","type":"HCPCS"},{"code":"63323012710","type":"NDC"}],"standard_charges":[{"gross_charge":234.98,"discounted_cash":82.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323013011","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"63323013011","type":"NDC"}],"standard_charges":[{"gross_charge":169.28,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MITOXANTRONE HCL INJ CONC 20 MG/10ML (2 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323013210","type":"CDM"},{"code":"J9293","type":"HCPCS"},{"code":"63323013210","type":"NDC"}],"standard_charges":[{"gross_charge":1020.79,"discounted_cash":357.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLADRIBINE IV SOLN 10 MG/10ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323014010","type":"CDM"},{"code":"J9065","type":"HCPCS"},{"code":"63323014010","type":"NDC"}],"standard_charges":[{"gross_charge":1122.24,"discounted_cash":392.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IFOSFAMIDE FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323014210","type":"CDM"},{"code":"J9208","type":"HCPCS"},{"code":"63323014210","type":"NDC"}],"standard_charges":[{"gross_charge":708.82,"discounted_cash":248.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.3333333333333333333,"type":"ML"},"code_information":[{"code":"Rx63323016201","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016201","type":"NDC"}],"standard_charges":[{"gross_charge":93.45,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.3333333333333333333,"type":"ML"},"code_information":[{"code":"Rx63323016212","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016212","type":"NDC"}],"standard_charges":[{"gross_charge":93.45,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 20 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323016505","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"63323016505","type":"NDC"}],"standard_charges":[{"gross_charge":93.77,"discounted_cash":32.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx63323017015","type":"CDM"},{"code":"63323017015","type":"NDC"}],"standard_charges":[{"gross_charge":219.74,"discounted_cash":76.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 600 MG/60ML","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx63323017260","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"63323017260","type":"NDC"}],"standard_charges":[{"gross_charge":630.06,"discounted_cash":220.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FOLIC ACID INJ 5 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323018411","type":"CDM"},{"code":"J1808","type":"HCPCS"},{"code":"63323018411","type":"NDC"}],"standard_charges":[{"gross_charge":93.61,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FLUDARABINE PHOSPHATE INJ 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323019202","type":"CDM"},{"code":"J9185","type":"HCPCS"},{"code":"63323019202","type":"NDC"}],"standard_charges":[{"gross_charge":2670.23,"discounted_cash":934.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323020102","type":"CDM"},{"code":"63323020102","type":"NDC"}],"standard_charges":[{"gross_charge":94.37,"discounted_cash":33.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323020110","type":"CDM"},{"code":"63323020110","type":"NDC"}],"standard_charges":[{"gross_charge":93.37,"discounted_cash":32.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MEPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323026037","type":"CDM"},{"code":"J0670","type":"HCPCS"},{"code":"63323026037","type":"NDC"}],"standard_charges":[{"gross_charge":94.17,"discounted_cash":32.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323026201","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323026201","type":"NDC"}],"standard_charges":[{"gross_charge":93.49,"discounted_cash":32.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323026255","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323026255","type":"NDC"}],"standard_charges":[{"gross_charge":93.61,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 1000 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323026530","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"63323026530","type":"NDC"}],"standard_charges":[{"gross_charge":351.23,"discounted_cash":122.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323027301","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"63323027301","type":"NDC"}],"standard_charges":[{"gross_charge":98.76,"discounted_cash":34.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx63323027602","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323027602","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"},{"gross_charge":98.09,"discounted_cash":34.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 300 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323028202","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"63323028202","type":"NDC"}],"standard_charges":[{"gross_charge":96.11,"discounted_cash":33.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 600 MG/4ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323028204","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"63323028204","type":"NDC"}],"standard_charges":[{"gross_charge":94.95,"discounted_cash":33.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 900 MG/6ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323028206","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"63323028206","type":"NDC"}],"standard_charges":[{"gross_charge":94.76,"discounted_cash":33.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028564","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028564","type":"NDC"}],"standard_charges":[{"gross_charge":94.15,"discounted_cash":32.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028605","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028605","type":"NDC"}],"standard_charges":[{"gross_charge":94.1,"discounted_cash":32.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MEPIVACAINE HCL INJ 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323029650","type":"CDM"},{"code":"J0670","type":"HCPCS"},{"code":"63323029650","type":"NDC"}],"standard_charges":[{"gross_charge":94.1,"discounted_cash":32.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOBRAMYCIN SULFATE FOR INJ 1.2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323030355","type":"CDM"},{"code":"63323030355","type":"NDC"}],"standard_charges":[{"gross_charge":741.41,"discounted_cash":259.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOBRAMYCIN SULFATE INJ 10 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323030502","type":"CDM"},{"code":"J3260","type":"HCPCS"},{"code":"63323030502","type":"NDC"}],"standard_charges":[{"gross_charge":97.8,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"},{"gross_charge":1.91,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TOBRAMYCIN SULFATE INJ 80 MG/2ML (40 MG/ML) (BASE EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323030655","type":"CDM"},{"code":"J3260","type":"HCPCS"},{"code":"63323030655","type":"NDC"}],"standard_charges":[{"gross_charge":94.28,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GRANISETRON HCL INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323031801","type":"CDM"},{"code":"J1626","type":"HCPCS"},{"code":"63323031801","type":"NDC"}],"standard_charges":[{"gross_charge":223.77,"discounted_cash":78.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEFUROXIME SODIUM FOR IV SOLN 1.5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323035345","type":"CDM"},{"code":"J0697","type":"HCPCS"},{"code":"63323035345","type":"NDC"}],"standard_charges":[{"gross_charge":98.21,"discounted_cash":34.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 50 MCG/ML (0.05 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323036501","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"63323036501","type":"NDC"}],"standard_charges":[{"gross_charge":97.96,"discounted_cash":34.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323038710","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"63323038710","type":"NDC"}],"standard_charges":[{"gross_charge":95.34,"discounted_cash":33.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323039810","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"63323039810","type":"NDC"}],"standard_charges":[{"gross_charge":100.05,"discounted_cash":35.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323039923","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"63323039923","type":"NDC"}],"standard_charges":[{"gross_charge":100.66,"discounted_cash":35.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CAFFEINE CITRATE INJ 60 MG/3ML (10 MG/ML BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx63323040703","type":"CDM"},{"code":"J0706","type":"HCPCS"},{"code":"63323040703","type":"NDC"}],"standard_charges":[{"gross_charge":319.43,"discounted_cash":111.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323043400","type":"CDM"},{"code":"J0134","type":"HCPCS"},{"code":"63323043400","type":"NDC"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx63323043441","type":"CDM"},{"code":"J0134","type":"HCPCS"},{"code":"63323043441","type":"NDC"}],"standard_charges":[{"gross_charge":98.06,"discounted_cash":34.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323045100","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"63323045100","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323045101","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"63323045101","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323046101","type":"CDM"},{"code":"63323046101","type":"NDC"}],"standard_charges":[{"gross_charge":101.8,"discounted_cash":35.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323046157","type":"CDM"},{"code":"63323046157","type":"NDC"}],"standard_charges":[{"gross_charge":199.36,"discounted_cash":69.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046802","type":"CDM"},{"code":"63323046802","type":"NDC"}],"standard_charges":[{"gross_charge":94.14,"discounted_cash":32.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046817","type":"CDM"},{"code":"63323046817","type":"NDC"}],"standard_charges":[{"gross_charge":96.75,"discounted_cash":33.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.75%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323047237","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"63323047237","type":"NDC"}],"standard_charges":[{"gross_charge":94.5,"discounted_cash":33.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.75% IN DEXTROSE INJ 8.25%","drug_information":{"unit":0.6666666666666666667,"type":"ML"},"code_information":[{"code":"Rx63323047302","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"63323047302","type":"NDC"}],"standard_charges":[{"gross_charge":94.5,"discounted_cash":33.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048201","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048201","type":"NDC"}],"standard_charges":[{"gross_charge":93.51,"discounted_cash":32.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048301","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048301","type":"NDC"}],"standard_charges":[{"gross_charge":93.34,"discounted_cash":32.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048357","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048357","type":"NDC"}],"standard_charges":[{"gross_charge":93.41,"discounted_cash":32.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048617","type":"CDM"},{"code":"63323048617","type":"NDC"}],"standard_charges":[{"gross_charge":93.41,"discounted_cash":32.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048731","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048731","type":"NDC"}],"standard_charges":[{"gross_charge":93.54,"discounted_cash":32.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323048901","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048901","type":"NDC"}],"standard_charges":[{"gross_charge":97.14,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049257","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"63323049257","type":"NDC"}],"standard_charges":[{"gross_charge":93.97,"discounted_cash":32.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323050600","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"63323050600","type":"NDC"}],"standard_charges":[{"gross_charge":93.47,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323050601","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"63323050601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx63323050616","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"63323050616","type":"NDC"}],"standard_charges":[{"gross_charge":2.32,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx63323051701","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323051701","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) 100 UNIT/ML IN D5W","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx63323052301","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323052301","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) 100 UNIT/ML IN D5W","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx63323052374","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323052374","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ARGATROBAN INJ 250 MG/2.5ML (CONCENTRATE FOR IV INFUSION)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx63323052603","type":"CDM"},{"code":"J0883","type":"HCPCS"},{"code":"63323052603","type":"NDC"}],"standard_charges":[{"gross_charge":2116.24,"discounted_cash":740.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML,HEPARIN SODIUM (PORCINE) PF 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":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323054036","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054036","type":"NDC"}],"standard_charges":[{"gross_charge":93.57,"discounted_cash":32.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 10000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323054201","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054201","type":"NDC"}],"standard_charges":[{"gross_charge":100.29,"discounted_cash":35.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 10000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323054207","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054207","type":"NDC"}],"standard_charges":[{"gross_charge":265.6,"discounted_cash":92.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx63323058421","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323058421","type":"NDC"}],"standard_charges":[{"gross_charge":144.01,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GLUCAGON HCL DIAGNOSTIC FOR INJ 1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323059611","type":"CDM"},{"code":"J1611","type":"HCPCS"},{"code":"63323059611","type":"NDC"}],"standard_charges":[{"gross_charge":1185.75,"discounted_cash":415.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLUCAGON HCL DIAGNOSTIC FOR INJ 1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323059613","type":"CDM"},{"code":"J1611","type":"HCPCS"},{"code":"63323059613","type":"NDC"}],"standard_charges":[{"gross_charge":1266.4,"discounted_cash":443.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLUCAGON HCL DIAGNOSTIC FOR INJ 1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323059616","type":"CDM"},{"code":"J1611","type":"HCPCS"},{"code":"63323059616","type":"NDC"}],"standard_charges":[{"gross_charge":1184.65,"discounted_cash":414.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMIODARONE HCL INJ 450 MG/9ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx63323061609","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"63323061609","type":"NDC"}],"standard_charges":[{"gross_charge":94.91,"discounted_cash":33.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ADENOSINE IV SOLN 6 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323065102","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"63323065102","type":"NDC"}],"standard_charges":[{"gross_charge":95.65,"discounted_cash":33.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CHLOROTHIAZIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323065827","type":"CDM"},{"code":"J1205","type":"HCPCS"},{"code":"63323065827","type":"NDC"}],"standard_charges":[{"gross_charge":500.19,"discounted_cash":175.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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":"Rx63323066005","type":"CDM"},{"code":"63323066005","type":"NDC"}],"standard_charges":[{"gross_charge":94.25,"discounted_cash":32.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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":"Rx63323068301","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323068301","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MESNA INJ 100 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323073311","type":"CDM"},{"code":"J9209","type":"HCPCS"},{"code":"63323073311","type":"NDC"}],"standard_charges":[{"gross_charge":728.47,"discounted_cash":254.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PACLITAXEL IV CONC 30 MG/5ML (6 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323076305","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"63323076305","type":"NDC"}],"standard_charges":[{"gross_charge":243.37,"discounted_cash":85.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PACLITAXEL IV CONC 100 MG/16.7ML (6 MG/ML)","drug_information":{"unit":16.7,"type":"ML"},"code_information":[{"code":"Rx63323076316","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"63323076316","type":"NDC"}],"standard_charges":[{"gross_charge":555.24,"discounted_cash":194.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323078110","type":"CDM"},{"code":"63323078110","type":"NDC"}],"standard_charges":[{"gross_charge":98.46,"discounted_cash":34.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 1000 MCG/20ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323080614","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"63323080614","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx63323082425","type":"CDM"},{"code":"63323082425","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx63323082426","type":"CDM"},{"code":"63323082426","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323087115","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"63323087115","type":"NDC"}],"standard_charges":[{"gross_charge":234.3,"discounted_cash":82.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323088305","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"63323088305","type":"NDC"}],"standard_charges":[{"gross_charge":286.04,"discounted_cash":100.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx63323088330","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"63323088330","type":"NDC"}],"standard_charges":[{"gross_charge":288.72,"discounted_cash":101.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx63323088401","type":"CDM"},{"code":"63323088401","type":"NDC"}],"standard_charges":[{"gross_charge":99.64,"discounted_cash":34.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM IV SOLN 100 MCG/5ML (20 MCG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323088510","type":"CDM"},{"code":"J0651","type":"HCPCS"},{"code":"63323088510","type":"NDC"}],"standard_charges":[{"gross_charge":732.48,"discounted_cash":256.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM IV SOLN 100 MCG/5ML (20 MCG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323088514","type":"CDM"},{"code":"J0651","type":"HCPCS"},{"code":"63323088514","type":"NDC"}],"standard_charges":[{"gross_charge":732.48,"discounted_cash":256.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63323096330","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"63323096330","type":"NDC"}],"standard_charges":[{"gross_charge":1129.29,"discounted_cash":395.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEVIMELINE HCL CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63395020113","type":"CDM"},{"code":"63395020113","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVALBUTEROL TARTRATE INHAL AEROSOL 45 MCG/ACT (BASE EQUIV)","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx63402051001","type":"CDM"},{"code":"63402051001","type":"NDC"}],"standard_charges":[{"gross_charge":62.25,"discounted_cash":21.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU CONC 1.25 MG/0.5ML (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63402051500","type":"CDM"},{"code":"J7612","type":"HCPCS"},{"code":"63402051500","type":"NDC"}],"standard_charges":[{"gross_charge":7.6,"discounted_cash":2.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"RITUXIMAB-ABBS IV SOLN 500 MG/50ML (10 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63459010450","type":"CDM"},{"code":"Q5115","type":"HCPCS"},{"code":"63459010450","type":"NDC"}],"standard_charges":[{"gross_charge":26046.8,"discounted_cash":9116.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63481068706","type":"CDM"},{"code":"63481068706","type":"NDC"}],"standard_charges":[{"gross_charge":33.42,"discounted_cash":11.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63653133202","type":"CDM"},{"code":"63653133202","type":"NDC"}],"standard_charges":[{"gross_charge":36.1,"discounted_cash":12.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE TAB 300-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739000410","type":"CDM"},{"code":"63739000410","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 10-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739004610","type":"CDM"},{"code":"63739004610","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739008010","type":"CDM"},{"code":"63739008010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLYBURIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739011910","type":"CDM"},{"code":"63739011910","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739012710","type":"CDM"},{"code":"63739012710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METHOCARBAMOL TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739016710","type":"CDM"},{"code":"63739016710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHENOBARBITAL TAB 32.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739020110","type":"CDM"},{"code":"63739020110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739026310","type":"CDM"},{"code":"63739026310","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TAMOXIFEN CITRATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739026910","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"63739026910","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"IBUPROFEN TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739044210","type":"CDM"},{"code":"63739044210","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739044710","type":"CDM"},{"code":"63739044710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739048310","type":"CDM"},{"code":"63739048310","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROPAFENONE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739050910","type":"CDM"},{"code":"63739050910","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 150 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739051210","type":"CDM"},{"code":"63739051210","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739053210","type":"CDM"},{"code":"63739053210","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739056410","type":"CDM"},{"code":"63739056410","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739056710","type":"CDM"},{"code":"63739056710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE ORALLY DISINTEGRATING TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739065310","type":"CDM"},{"code":"63739065310","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739067110","type":"CDM"},{"code":"63739067110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739067310","type":"CDM"},{"code":"63739067310","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739067510","type":"CDM"},{"code":"63739067510","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739068410","type":"CDM"},{"code":"63739068410","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739068610","type":"CDM"},{"code":"63739068610","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"IBUPROFEN TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739069110","type":"CDM"},{"code":"63739069110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63739069457","type":"CDM"},{"code":"63739069457","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739070410","type":"CDM"},{"code":"63739070410","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64125013601","type":"CDM"},{"code":"64125013601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ANTIINHIBITOR COAGULANT COMPLEX FOR IV SOLN 1000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64193022402","type":"CDM"},{"code":"J7198","type":"HCPCS"},{"code":"64193022402","type":"NDC"}],"standard_charges":[{"gross_charge":25200.0,"discounted_cash":8820.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) LOCK FLUSH PF IV SOLN 100 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx64253033335","type":"CDM"},{"code":"J1642","type":"HCPCS"},{"code":"64253033335","type":"NDC"}],"standard_charges":[{"gross_charge":93.45,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) LOCK FLUSH PF IV SOLN 1 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx64253044422","type":"CDM"},{"code":"J1642","type":"HCPCS"},{"code":"64253044422","type":"NDC"}],"standard_charges":[{"gross_charge":96.76,"discounted_cash":33.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHIMAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64376065601","type":"CDM"},{"code":"64376065601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MEGESTROL ACETATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380015801","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"64380015801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROPAFENONE HCL CAP ER 12HR 225 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380018401","type":"CDM"},{"code":"64380018401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380072506","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"64380072506","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380072606","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"64380072606","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380074106","type":"CDM"},{"code":"64380074106","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NATALIZUMAB FOR IV INJ CONC 300 MG/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx64406000801","type":"CDM"},{"code":"J2323","type":"HCPCS"},{"code":"64406000801","type":"NDC"}],"standard_charges":[{"gross_charge":87328.62,"discounted_cash":30565.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROMETHORPHAN HBR-QUINIDINE SULFATE CAP 20-10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64597030160","type":"CDM"},{"code":"64597030160","type":"NDC"}],"standard_charges":[{"gross_charge":36.07,"discounted_cash":12.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx64679005601","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"64679005601","type":"NDC"}],"standard_charges":[{"gross_charge":96.93,"discounted_cash":33.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROMETHAZINE-DM SYRUP 6.25-15 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx64679060416","type":"CDM"},{"code":"64679060416","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679070302","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"64679070302","type":"NDC"}],"standard_charges":[{"gross_charge":96.09,"discounted_cash":33.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679071704","type":"CDM"},{"code":"64679071704","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 150 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679071801","type":"CDM"},{"code":"64679071801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ONDANSETRON HCL INJ 40 MG/20ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx64679072701","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"64679072701","type":"NDC"}],"standard_charges":[{"gross_charge":94.56,"discounted_cash":33.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679073502","type":"CDM"},{"code":"64679073502","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ENTACAPONE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679078102","type":"CDM"},{"code":"64679078102","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CAPTOPRIL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679090301","type":"CDM"},{"code":"64679090301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679092101","type":"CDM"},{"code":"64679092101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ZONISAMIDE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679094501","type":"CDM"},{"code":"64679094501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ZONISAMIDE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679094601","type":"CDM"},{"code":"64679094601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROCORTISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64720033105","type":"CDM"},{"code":"64720033105","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"THYROID TAB 130 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64727330801","type":"CDM"},{"code":"64727330801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 15 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64764015105","type":"CDM"},{"code":"64764015105","type":"NDC"}],"standard_charges":[{"gross_charge":14.61,"discounted_cash":5.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA CAP ER 36.25-145 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64896066201","type":"CDM"},{"code":"64896066201","type":"NDC"}],"standard_charges":[{"gross_charge":5.71,"discounted_cash":2.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA CAP ER 61.25-245 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64896066401","type":"CDM"},{"code":"64896066401","type":"NDC"}],"standard_charges":[{"gross_charge":7.17,"discounted_cash":2.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ISONIAZID TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64950021610","type":"CDM"},{"code":"64950021610","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"POT PHOS MONOBASIC W/SOD PHOS DI & MONOBAS TAB 155-852-130MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980010401","type":"CDM"},{"code":"64980010401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLYCOPYRROLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980025801","type":"CDM"},{"code":"64980025801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MESALAMINE SUPPOS 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980028203","type":"CDM"},{"code":"64980028203","type":"NDC"}],"standard_charges":[{"gross_charge":4.65,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCORTISONE PERIANAL CREAM 2.5%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx64980032430","type":"CDM"},{"code":"64980032430","type":"NDC"}],"standard_charges":[{"gross_charge":12.64,"discounted_cash":4.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN PALMITATE HCL FOR SOLN 75 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx64980051110","type":"CDM"},{"code":"64980051110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OFLOXACIN OPHTH SOLN 0.3%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx64980051501","type":"CDM"},{"code":"64980051501","type":"NDC"}],"standard_charges":[{"gross_charge":41.85,"discounted_cash":14.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OFLOXACIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx64980051505","type":"CDM"},{"code":"64980051505","type":"NDC"}],"standard_charges":[{"gross_charge":20.92,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHENYTOIN CHEW TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980057301","type":"CDM"},{"code":"64980057301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 400-80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162027110","type":"CDM"},{"code":"65162027110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 25 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162030009","type":"CDM"},{"code":"65162030009","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SALSALATE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162051210","type":"CDM"},{"code":"65162051210","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SALSALATE TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162051310","type":"CDM"},{"code":"65162051310","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BETHANECHOL CHLORIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162057310","type":"CDM"},{"code":"65162057310","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162063609","type":"CDM"},{"code":"65162063609","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162064210","type":"CDM"},{"code":"65162064210","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXCARBAZEPINE SUSP 300 MG/5ML (60 MG/ML)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx65162064978","type":"CDM"},{"code":"65162064978","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RISPERIDONE SOLN 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx65162067384","type":"CDM"},{"code":"65162067384","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NITROFURANTOIN SUSP 25 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx65162068988","type":"CDM"},{"code":"65162068988","type":"NDC"}],"standard_charges":[{"gross_charge":29.43,"discounted_cash":10.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GABAPENTIN ORAL SOLN 250 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx65162069890","type":"CDM"},{"code":"65162069890","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162075110","type":"CDM"},{"code":"65162075110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ACYCLOVIR OINT 5%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx65162083594","type":"CDM"},{"code":"65162083594","type":"NDC"}],"standard_charges":[{"gross_charge":17.23,"discounted_cash":6.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LUBIPROSTONE CAP 24 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162084206","type":"CDM"},{"code":"65162084206","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162089603","type":"CDM"},{"code":"65162089603","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TOBRAMYCIN NEBU SOLN 300 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65162091446","type":"CDM"},{"code":"J7682","type":"HCPCS"},{"code":"65162091446","type":"NDC"}],"standard_charges":[{"gross_charge":23.66,"discounted_cash":8.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.075 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162099504","type":"CDM"},{"code":"65162099504","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":3.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.075 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162099508","type":"CDM"},{"code":"65162099508","type":"NDC"}],"standard_charges":[{"gross_charge":12.58,"discounted_cash":4.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TRIAMTERENE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65197000201","type":"CDM"},{"code":"65197000201","type":"NDC"}],"standard_charges":[{"gross_charge":13.44,"discounted_cash":4.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65219001601","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"65219001601","type":"NDC"}],"standard_charges":[{"gross_charge":95.51,"discounted_cash":33.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx65219014202","type":"CDM"},{"code":"65219014202","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETAMINE HCL INJ 50 MG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx65219018801","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"65219018801","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx65219025701","type":"CDM"},{"code":"65219025701","type":"NDC"}],"standard_charges":[{"gross_charge":93.89,"discounted_cash":32.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DESMOPRESSIN ACETATE INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx65219029510","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"65219029510","type":"NDC"}],"standard_charges":[{"gross_charge":96.62,"discounted_cash":33.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE LIPOSOME INJ 1.3% (13.3 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx65250013304","type":"CDM"},{"code":"J0666","type":"HCPCS"},{"code":"65250013304","type":"NDC"}],"standard_charges":[{"gross_charge":212.09,"discounted_cash":74.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE FOR IV SOLN 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65293000101","type":"CDM"},{"code":"J0583","type":"HCPCS"},{"code":"65293000101","type":"NDC"}],"standard_charges":[{"gross_charge":9983.98,"discounted_cash":3494.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ORITAVANCIN DIPHOSPHATE FOR IV SOLN 400 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65293001503","type":"CDM"},{"code":"J2406","type":"HCPCS"},{"code":"65293001503","type":"NDC"}],"standard_charges":[{"gross_charge":10353.24,"discounted_cash":3623.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALDESLEUKIN FOR IV SOLN 22000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65483011607","type":"CDM"},{"code":"J9015","type":"HCPCS"},{"code":"65483011607","type":"NDC"}],"standard_charges":[{"gross_charge":44687.02,"discounted_cash":15640.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OLMESARTAN MEDOXOMIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65597010130","type":"CDM"},{"code":"65597010130","type":"NDC"}],"standard_charges":[{"gross_charge":9.13,"discounted_cash":3.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OLMESARTAN MEDOXOMIL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65597010430","type":"CDM"},{"code":"65597010430","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIPHENHYD-LIDO-AL HYDROX-MG HYDROX-SIMETH SUSP (CMPD KIT)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx65628005001","type":"CDM"},{"code":"65628005001","type":"NDC"}],"standard_charges":[{"gross_charge":10.86,"discounted_cash":3.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIPHENHYD-LIDO-AL HYDROX-MG HYDROX-SIMETH SUSP (CMPD KIT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65628005001","type":"CDM"},{"code":"65628005001","type":"NDC"}],"standard_charges":[{"gross_charge":3.62,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROGESTERONE VAGINAL SUPPOSITORY 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65628006301","type":"CDM"},{"code":"65628006301","type":"NDC"}],"standard_charges":[{"gross_charge":8.56,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LANSOPRAZOLE SUSP 3 MG/ML (COMPOUND KIT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65628008003","type":"CDM"},{"code":"65628008003","type":"NDC"}],"standard_charges":[{"gross_charge":13.36,"discounted_cash":4.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METRONIDAZOLE BENZOATE FOR SUSP 50 MG/ML (CMPD KIT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65628020205","type":"CDM"},{"code":"65628020205","type":"NDC"}],"standard_charges":[{"gross_charge":3.43,"discounted_cash":1.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR ORAL SOLN 50 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx65628020810","type":"CDM"},{"code":"65628020810","type":"NDC"}],"standard_charges":[{"gross_charge":2.28,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROCORTISONE ACETATE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65649041112","type":"CDM"},{"code":"65649041112","type":"NDC"}],"standard_charges":[{"gross_charge":9.1,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MIRTAZAPINE ORALLY DISINTEGRATING TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862002106","type":"CDM"},{"code":"65862002106","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862006201","type":"CDM"},{"code":"65862006201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 400 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65862007150","type":"CDM"},{"code":"65862007150","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862011701","type":"CDM"},{"code":"65862011701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862018601","type":"CDM"},{"code":"65862018601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862020390","type":"CDM"},{"code":"65862020390","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LAMOTRIGINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862022701","type":"CDM"},{"code":"65862022701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LAMOTRIGINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862023060","type":"CDM"},{"code":"65862023060","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862029390","type":"CDM"},{"code":"65862029390","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LAMOTRIGINE TAB CHEWABLE DISPERSIBLE 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862036101","type":"CDM"},{"code":"65862036101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 500-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862050220","type":"CDM"},{"code":"65862050220","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 600-42.9 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65862053513","type":"CDM"},{"code":"65862053513","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862055990","type":"CDM"},{"code":"65862055990","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862059401","type":"CDM"},{"code":"65862059401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLINDAMYCIN PALMITATE HCL FOR SOLN 75 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65862059601","type":"CDM"},{"code":"65862059601","type":"NDC"}],"standard_charges":[{"gross_charge":3.23,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"RIVASTIGMINE TARTRATE CAP 3 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862064960","type":"CDM"},{"code":"65862064960","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 150 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862069730","type":"CDM"},{"code":"65862069730","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862069920","type":"CDM"},{"code":"65862069920","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65862070780","type":"CDM"},{"code":"65862070780","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CLOZAPINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862084401","type":"CDM"},{"code":"65862084401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CELECOXIB CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862090901","type":"CDM"},{"code":"65862090901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx66220020730","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"66220020730","type":"NDC"}],"standard_charges":[{"gross_charge":255.36,"discounted_cash":89.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"INDOCYANINE GREEN FOR INJ SOLN 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66259014601","type":"CDM"},{"code":"66259014601","type":"NDC"}],"standard_charges":[{"gross_charge":93.25,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66582041429","type":"CDM"},{"code":"66582041429","type":"NDC"}],"standard_charges":[{"gross_charge":14.65,"discounted_cash":5.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66582041454","type":"CDM"},{"code":"66582041454","type":"NDC"}],"standard_charges":[{"gross_charge":16.08,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 0.9% IV SOLN 30 UNIT/500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx66647614444","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"66647614444","type":"NDC"}],"standard_charges":[{"gross_charge":249.5,"discounted_cash":87.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL-SODIUM CHLORIDE IV SOLN 1 GM/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx66647616433","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"66647616433","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx66685101201","type":"CDM"},{"code":"66685101201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689002350","type":"CDM"},{"code":"66689002350","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHENYTOIN SUSP 125 MG/5ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx66689003601","type":"CDM"},{"code":"66689003601","type":"NDC"}],"standard_charges":[{"gross_charge":1.86,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ARIPIPRAZOLE ORAL SOLUTION 1 MG/ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx66689073505","type":"CDM"},{"code":"66689073505","type":"NDC"}],"standard_charges":[{"gross_charge":3.48,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CYSTEINE HCL INJ 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx66758000402","type":"CDM"},{"code":"66758000402","type":"NDC"}],"standard_charges":[{"gross_charge":98.45,"discounted_cash":34.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CIPROFLOXACIN-HYDROCORTISONE OTIC SUSP 0.2-1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx66758008770","type":"CDM"},{"code":"66758008770","type":"NDC"}],"standard_charges":[{"gross_charge":501.3,"discounted_cash":175.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66758014983","type":"CDM"},{"code":"66758014983","type":"NDC"}],"standard_charges":[{"gross_charge":26.46,"discounted_cash":9.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66758019006","type":"CDM"},{"code":"66758019006","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66758020854","type":"CDM"},{"code":"66758020854","type":"NDC"}],"standard_charges":[{"gross_charge":25.76,"discounted_cash":9.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66758020858","type":"CDM"},{"code":"66758020858","type":"NDC"}],"standard_charges":[{"gross_charge":25.95,"discounted_cash":9.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ISOFLURANE INHAL SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx66794001910","type":"CDM"},{"code":"66794001910","type":"NDC"}],"standard_charges":[{"gross_charge":21.15,"discounted_cash":7.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993005381","type":"CDM"},{"code":"66993005381","type":"NDC"}],"standard_charges":[{"gross_charge":7.12,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CARBAMAZEPINE CAP ER 12HR 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993040832","type":"CDM"},{"code":"66993040832","type":"NDC"}],"standard_charges":[{"gross_charge":2.33,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MIRTAZAPINE ORALLY DISINTEGRATING TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993070930","type":"CDM"},{"code":"66993070930","type":"NDC"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MIRTAZAPINE ORALLY DISINTEGRATING TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993070951","type":"CDM"},{"code":"66993070951","type":"NDC"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CALCIPOTRIENE CREAM 0.005%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx66993087761","type":"CDM"},{"code":"66993087761","type":"NDC"}],"standard_charges":[{"gross_charge":110.61,"discounted_cash":38.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ASCORBIC ACID IV SOLN 25000 MG/50ML (500 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx67157010150","type":"CDM"},{"code":"67157010150","type":"NDC"}],"standard_charges":[{"gross_charge":2778.16,"discounted_cash":972.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67253038110","type":"CDM"},{"code":"67253038110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYALURONIDASE OVINE INJ 200 UNIT/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx67425000210","type":"CDM"},{"code":"J3471","type":"HCPCS"},{"code":"67425000210","type":"NDC"}],"standard_charges":[{"gross_charge":425.91,"discounted_cash":149.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETAMINE HCL INJ 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457000100","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"67457000100","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETAMINE HCL INJ 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457000110","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"67457000110","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx67457015300","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"67457015300","type":"NDC"}],"standard_charges":[{"gross_charge":97.28,"discounted_cash":34.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx67457015303","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"67457015303","type":"NDC"}],"standard_charges":[{"gross_charge":97.28,"discounted_cash":34.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMIODARONE HCL INJ 450 MG/9ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx67457015309","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"67457015309","type":"NDC"}],"standard_charges":[{"gross_charge":95.37,"discounted_cash":33.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SODIUM TETRADECYL SULFATE INJ 3%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457016300","type":"CDM"},{"code":"67457016300","type":"NDC"}],"standard_charges":[{"gross_charge":811.03,"discounted_cash":283.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIMETHYL SULFOXIDE SOLN 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx67457017750","type":"CDM"},{"code":"J1212","type":"HCPCS"},{"code":"67457017750","type":"NDC"}],"standard_charges":[{"gross_charge":7493.92,"discounted_cash":2622.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETAMINE HCL INJ 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457018120","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"67457018120","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESMOLOL HCL INJ 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457018200","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"67457018200","type":"NDC"}],"standard_charges":[{"gross_charge":99.74,"discounted_cash":34.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESMOLOL HCL INJ 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457018210","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"67457018210","type":"NDC"}],"standard_charges":[{"gross_charge":99.34,"discounted_cash":34.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457019600","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"67457019600","type":"NDC"}],"standard_charges":[{"gross_charge":97.2,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CLONIDINE HCL INJ (FOR EPIDURAL INFUSION) 100 MCG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457021810","type":"CDM"},{"code":"J0735","type":"HCPCS"},{"code":"67457021810","type":"NDC"}],"standard_charges":[{"gross_charge":122.08,"discounted_cash":42.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 50 MG/2ML (25 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457022102","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"67457022102","type":"NDC"}],"standard_charges":[{"gross_charge":263.67,"discounted_cash":92.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OCTREOTIDE ACETATE SUBCUTANEOUS SOLN PREF SYR 50 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457023901","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"67457023901","type":"NDC"}],"standard_charges":[{"gross_charge":96.64,"discounted_cash":33.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OCTREOTIDE ACETATE SUBCUTANEOUS SOLN PREF SYR 100 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457024500","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"67457024500","type":"NDC"}],"standard_charges":[{"gross_charge":98.1,"discounted_cash":34.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OCTREOTIDE ACETATE SUBCUTANEOUS SOLN PREF SYR 500 MCG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx67457024601","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"67457024601","type":"NDC"}],"standard_charges":[{"gross_charge":96.71,"discounted_cash":33.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx67457031105","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"67457031105","type":"NDC"}],"standard_charges":[{"gross_charge":1500.56,"discounted_cash":525.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457033950","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"67457033950","type":"NDC"}],"standard_charges":[{"gross_charge":100.52,"discounted_cash":35.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457034815","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"67457034815","type":"NDC"}],"standard_charges":[{"gross_charge":94.58,"discounted_cash":33.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457034903","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"67457034903","type":"NDC"}],"standard_charges":[{"gross_charge":96.9,"discounted_cash":33.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457035202","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"67457035202","type":"NDC"}],"standard_charges":[{"gross_charge":99.84,"discounted_cash":34.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457038499","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"67457038499","type":"NDC"}],"standard_charges":[{"gross_charge":93.45,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ESOMEPRAZOLE SODIUM FOR INTRAVENOUS SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457039299","type":"CDM"},{"code":"J1370","type":"HCPCS"},{"code":"67457039299","type":"NDC"}],"standard_charges":[{"gross_charge":100.63,"discounted_cash":35.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457042612","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"67457042612","type":"NDC"}],"standard_charges":[{"gross_charge":93.75,"discounted_cash":32.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457043710","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"67457043710","type":"NDC"}],"standard_charges":[{"gross_charge":171.14,"discounted_cash":59.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYTARABINE INJ PF 100 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx67457045220","type":"CDM"},{"code":"J9100","type":"HCPCS"},{"code":"67457045220","type":"NDC"}],"standard_charges":[{"gross_charge":316.82,"discounted_cash":110.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 50 MG/2ML (25 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457046721","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"67457046721","type":"NDC"}],"standard_charges":[{"gross_charge":264.12,"discounted_cash":92.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 50 MG/2ML (25 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457046799","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"67457046799","type":"NDC"}],"standard_charges":[{"gross_charge":264.09,"discounted_cash":92.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOBRAMYCIN SULFATE INJ 80 MG/2ML (40 MG/ML) (BASE EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457047300","type":"CDM"},{"code":"J3260","type":"HCPCS"},{"code":"67457047300","type":"NDC"}],"standard_charges":[{"gross_charge":95.08,"discounted_cash":33.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 1000 MG/40ML (25 MG/ML)","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx67457048040","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"67457048040","type":"NDC"}],"standard_charges":[{"gross_charge":525.19,"discounted_cash":183.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx67457052100","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"67457052100","type":"NDC"}],"standard_charges":[{"gross_charge":101.71,"discounted_cash":35.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457052810","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"67457052810","type":"NDC"}],"standard_charges":[{"gross_charge":315.01,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GEMCITABINE HCL INJ 1 GM/26.3ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":26.3,"type":"ML"},"code_information":[{"code":"Rx67457061730","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"67457061730","type":"NDC"}],"standard_charges":[{"gross_charge":236.38,"discounted_cash":82.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457062102","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"67457062102","type":"NDC"}],"standard_charges":[{"gross_charge":97.32,"discounted_cash":34.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457064099","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"67457064099","type":"NDC"}],"standard_charges":[{"gross_charge":189.92,"discounted_cash":66.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CALCITONIN (SALMON) INJ 200 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457067502","type":"CDM"},{"code":"J0630","type":"HCPCS"},{"code":"67457067502","type":"NDC"}],"standard_charges":[{"gross_charge":4981.64,"discounted_cash":1743.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx67457079920","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"67457079920","type":"NDC"}],"standard_charges":[{"gross_charge":94.04,"discounted_cash":32.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx67457079999","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"67457079999","type":"NDC"}],"standard_charges":[{"gross_charge":93.92,"discounted_cash":32.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PEGFILGRASTIM-JMDB SOLN PREFILLED SYRINGE 6 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx67457083306","type":"CDM"},{"code":"Q5108","type":"HCPCS"},{"code":"67457083306","type":"NDC"}],"standard_charges":[{"gross_charge":13835.43,"discounted_cash":4842.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx67457084300","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"67457084300","type":"NDC"}],"standard_charges":[{"gross_charge":741.24,"discounted_cash":259.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TRASTUZUMAB-DKST FOR IV SOLN 420 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457084744","type":"CDM"},{"code":"Q5114","type":"HCPCS"},{"code":"67457084744","type":"NDC"}],"standard_charges":[{"gross_charge":13613.57,"discounted_cash":4764.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ADENOSINE IV SOLN 6 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457085502","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"67457085502","type":"NDC"}],"standard_charges":[{"gross_charge":94.96,"discounted_cash":33.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NITAZOXANIDE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67546011112","type":"CDM"},{"code":"67546011112","type":"NDC"}],"standard_charges":[{"gross_charge":186.46,"discounted_cash":65.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx67877012405","type":"CDM"},{"code":"67877012405","type":"NDC"}],"standard_charges":[{"gross_charge":13.72,"discounted_cash":4.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx67877012450","type":"CDM"},{"code":"67877012450","type":"NDC"}],"standard_charges":[{"gross_charge":13.72,"discounted_cash":4.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877021660","type":"CDM"},{"code":"67877021660","type":"NDC"}],"standard_charges":[{"gross_charge":1.91,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877022301","type":"CDM"},{"code":"67877022301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL FOR ORAL SUSP 200 MG/ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx67877023022","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"67877023022","type":"NDC"}],"standard_charges":[{"gross_charge":12.64,"discounted_cash":4.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877024601","type":"CDM"},{"code":"67877024601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"RASAGILINE MESYLATE TAB 0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877025930","type":"CDM"},{"code":"67877025930","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RILUZOLE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877028660","type":"CDM"},{"code":"67877028660","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CHOLESTYRAMINE POWDER PACKETS 4 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877029809","type":"CDM"},{"code":"67877029809","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877043103","type":"CDM"},{"code":"67877043103","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877049030","type":"CDM"},{"code":"67877049030","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RANOLAZINE TAB ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877052560","type":"CDM"},{"code":"67877052560","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEFDINIR FOR SUSP 125 MG/5ML","drug_information":{"unit":12.0,"type":"ML"},"code_information":[{"code":"Rx67877054798","type":"CDM"},{"code":"67877054798","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFDINIR FOR SUSP 250 MG/5ML","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx67877054898","type":"CDM"},{"code":"67877054898","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PRASUGREL HCL TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877060530","type":"CDM"},{"code":"67877060530","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CHLORTHALIDONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877069601","type":"CDM"},{"code":"67877069601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67919001101","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"67919001101","type":"NDC"}],"standard_charges":[{"gross_charge":4624.7,"discounted_cash":1618.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYOSCYAMINE SULFATE SL TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68047025301","type":"CDM"},{"code":"68047025301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084000911","type":"CDM"},{"code":"68084000911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084001911","type":"CDM"},{"code":"68084001911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084005211","type":"CDM"},{"code":"68084005211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084005611","type":"CDM"},{"code":"68084005611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084006911","type":"CDM"},{"code":"68084006911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009701","type":"CDM"},{"code":"68084009701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GLIPIZIDE TAB ER 24HR 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084011211","type":"CDM"},{"code":"68084011211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MIRTAZAPINE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084011911","type":"CDM"},{"code":"68084011911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MIRTAZAPINE TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084012011","type":"CDM"},{"code":"68084012011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DRONABINOL CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084017521","type":"CDM"},{"code":"68084017521","type":"NDC"}],"standard_charges":[{"gross_charge":11.62,"discounted_cash":4.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RIBAVIRIN CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084017911","type":"CDM"},{"code":"68084017911","type":"NDC"}],"standard_charges":[{"gross_charge":14.88,"discounted_cash":5.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SERTRALINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084018111","type":"CDM"},{"code":"68084018111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SPIRONOLACTONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020711","type":"CDM"},{"code":"68084020711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"URSODIOL CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084021311","type":"CDM"},{"code":"68084021311","type":"NDC"}],"standard_charges":[{"gross_charge":3.48,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084023001","type":"CDM"},{"code":"68084023001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084025311","type":"CDM"},{"code":"68084025311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TERBUTALINE SULFATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084025711","type":"CDM"},{"code":"68084025711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARVEDILOL TAB 6.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084026211","type":"CDM"},{"code":"68084026211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARVEDILOL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084026301","type":"CDM"},{"code":"68084026301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARVEDILOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084026411","type":"CDM"},{"code":"68084026411","type":"NDC"}],"standard_charges":[{"gross_charge":2.92,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RAMIPRIL CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084026611","type":"CDM"},{"code":"68084026611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METHIMAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084027611","type":"CDM"},{"code":"68084027611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MINOCYCLINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028911","type":"CDM"},{"code":"68084028911","type":"NDC"}],"standard_charges":[{"gross_charge":2.51,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLIPIZIDE TAB ER 24HR 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084029511","type":"CDM"},{"code":"68084029511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLIPIZIDE TAB ER 24HR 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084029521","type":"CDM"},{"code":"68084029521","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084030411","type":"CDM"},{"code":"68084030411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MERCAPTOPURINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084032511","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"68084032511","type":"NDC"}],"standard_charges":[{"gross_charge":2.19,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLIMEPIRIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084032601","type":"CDM"},{"code":"68084032601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLIMEPIRIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084032611","type":"CDM"},{"code":"68084032611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084033011","type":"CDM"},{"code":"68084033011","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084033111","type":"CDM"},{"code":"68084033111","type":"NDC"}],"standard_charges":[{"gross_charge":3.27,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LEVETIRACETAM TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084033611","type":"CDM"},{"code":"68084033611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084033711","type":"CDM"},{"code":"68084033711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TOPIRAMATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034411","type":"CDM"},{"code":"68084034411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034811","type":"CDM"},{"code":"68084034811","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084035501","type":"CDM"},{"code":"68084035501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"RIFAMPIN CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084035721","type":"CDM"},{"code":"68084035721","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RIFAMPIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084035811","type":"CDM"},{"code":"68084035811","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084036011","type":"CDM"},{"code":"68084036011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084036811","type":"CDM"},{"code":"68084036811","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CARISOPRODOL TAB 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084038011","type":"CDM"},{"code":"68084038011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084038111","type":"CDM"},{"code":"68084038111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ENALAPRIL MALEATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084039011","type":"CDM"},{"code":"68084039011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084039611","type":"CDM"},{"code":"68084039611","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ACETAZOLAMIDE CAP ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084040111","type":"CDM"},{"code":"68084040111","type":"NDC"}],"standard_charges":[{"gross_charge":4.61,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084040711","type":"CDM"},{"code":"68084040711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"INDOMETHACIN CAP ER 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084041111","type":"CDM"},{"code":"68084041111","type":"NDC"}],"standard_charges":[{"gross_charge":2.63,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084044711","type":"CDM"},{"code":"68084044711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LABETALOL HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084045611","type":"CDM"},{"code":"68084045611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NATEGLINIDE TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084045811","type":"CDM"},{"code":"68084045811","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ZIDOVUDINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084046111","type":"CDM"},{"code":"68084046111","type":"NDC"}],"standard_charges":[{"gross_charge":2.82,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084047101","type":"CDM"},{"code":"68084047101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084047111","type":"CDM"},{"code":"68084047111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084048511","type":"CDM"},{"code":"68084048511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 150 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084048611","type":"CDM"},{"code":"68084048611","type":"NDC"}],"standard_charges":[{"gross_charge":3.97,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GLYCOPYRROLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084049911","type":"CDM"},{"code":"68084049911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084053001","type":"CDM"},{"code":"68084053001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TEMAZEPAM CAP 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084054911","type":"CDM"},{"code":"68084054911","type":"NDC"}],"standard_charges":[{"gross_charge":7.34,"discounted_cash":2.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARBAMAZEPINE TAB ER 12HR 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084056111","type":"CDM"},{"code":"68084056111","type":"NDC"}],"standard_charges":[{"gross_charge":3.63,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084056311","type":"CDM"},{"code":"68084056311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084056511","type":"CDM"},{"code":"68084056511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LAMIVUDINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084057811","type":"CDM"},{"code":"68084057811","type":"NDC"}],"standard_charges":[{"gross_charge":10.54,"discounted_cash":3.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084058711","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"68084058711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084058911","type":"CDM"},{"code":"68084058911","type":"NDC"}],"standard_charges":[{"gross_charge":4.48,"discounted_cash":1.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059501","type":"CDM"},{"code":"68084059501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PERPHENAZINE TAB 8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084060701","type":"CDM"},{"code":"68084060701","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SILDENAFIL CITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084062211","type":"CDM"},{"code":"68084062211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084062511","type":"CDM"},{"code":"68084062511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 15 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084062911","type":"CDM"},{"code":"68084062911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084063211","type":"CDM"},{"code":"68084063211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084065711","type":"CDM"},{"code":"68084065711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IBUPROFEN TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084065801","type":"CDM"},{"code":"68084065801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IBUPROFEN TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084065811","type":"CDM"},{"code":"68084065811","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084067601","type":"CDM"},{"code":"68084067601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"IBUPROFEN TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084077211","type":"CDM"},{"code":"68084077211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084077401","type":"CDM"},{"code":"68084077401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084078301","type":"CDM"},{"code":"68084078301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084078311","type":"CDM"},{"code":"68084078311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084079711","type":"CDM"},{"code":"68084079711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OXCARBAZEPINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084084511","type":"CDM"},{"code":"68084084511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARVEDILOL TAB 6.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084085401","type":"CDM"},{"code":"68084085401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARVEDILOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084087611","type":"CDM"},{"code":"68084087611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084088409","type":"CDM"},{"code":"68084088409","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084088411","type":"CDM"},{"code":"68084088411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DESIPRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084097295","type":"CDM"},{"code":"68084097295","type":"NDC"}],"standard_charges":[{"gross_charge":2.47,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXYCODONE HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084098311","type":"CDM"},{"code":"68084098311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VALPROATE SODIUM ORAL SOLN 250 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094019361","type":"CDM"},{"code":"68094019361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094059959","type":"CDM"},{"code":"68094059959","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68094071659","type":"CDM"},{"code":"68094071659","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68094090030","type":"CDM"},{"code":"68094090030","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BELINOSTAT FOR IV INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68152010809","type":"CDM"},{"code":"J9032","type":"HCPCS"},{"code":"68152010809","type":"NDC"}],"standard_charges":[{"gross_charge":20408.27,"discounted_cash":7142.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180011316","type":"CDM"},{"code":"68180011316","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FAMOTIDINE FOR SUSP 40 MG/5ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx68180015001","type":"CDM"},{"code":"68180015001","type":"NDC"}],"standard_charges":[{"gross_charge":3.45,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180021109","type":"CDM"},{"code":"68180021109","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYCLOSPORINE (OPHTH) EMULSION 0.05%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180021430","type":"CDM"},{"code":"68180021430","type":"NDC"}],"standard_charges":[{"gross_charge":5.34,"discounted_cash":1.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MEMANTINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180022907","type":"CDM"},{"code":"68180022907","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVOFLOXACIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180024101","type":"CDM"},{"code":"68180024101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ETHAMBUTOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180028001","type":"CDM"},{"code":"68180028001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180030320","type":"CDM"},{"code":"68180030320","type":"NDC"}],"standard_charges":[{"gross_charge":4.92,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180033107","type":"CDM"},{"code":"68180033107","type":"NDC"}],"standard_charges":[{"gross_charge":1.84,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180051309","type":"CDM"},{"code":"68180051309","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB ER 24HR 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180061207","type":"CDM"},{"code":"68180061207","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DOXYCYCLINE MONOHYDRATE FOR SUSP 25 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx68180065701","type":"CDM"},{"code":"68180065701","type":"NDC"}],"standard_charges":[{"gross_charge":2.91,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CEFDINIR CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180071160","type":"CDM"},{"code":"68180071160","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFDINIR FOR SUSP 250 MG/5ML","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx68180072304","type":"CDM"},{"code":"68180072304","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180086106","type":"CDM"},{"code":"68180086106","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCORTISONE ACETATE W/ PRAMOXINE PERIANAL FOAM 1-1%","drug_information":{"unit":10.0,"type":"GM"},"code_information":[{"code":"Rx68220014210","type":"CDM"},{"code":"68220014210","type":"NDC"}],"standard_charges":[{"gross_charge":93.88,"discounted_cash":32.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TOPIRAMATE SPRINKLE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382000514","type":"CDM"},{"code":"68382000514","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LAMOTRIGINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382001014","type":"CDM"},{"code":"68382001014","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METFORMIN HCL TAB 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382003001","type":"CDM"},{"code":"68382003001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382009601","type":"CDM"},{"code":"68382009601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PAROXETINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382009716","type":"CDM"},{"code":"68382009716","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIVALPROEX SODIUM CAP DELAYED RELEASE SPRINKLE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382010601","type":"CDM"},{"code":"68382010601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382013201","type":"CDM"},{"code":"68382013201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOPIRAMATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382014014","type":"CDM"},{"code":"68382014014","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE ORALLY DISINTEGRATING TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382034706","type":"CDM"},{"code":"68382034706","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382035306","type":"CDM"},{"code":"68382035306","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FAMOTIDINE FOR SUSP 40 MG/5ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx68382044405","type":"CDM"},{"code":"68382044405","type":"NDC"}],"standard_charges":[{"gross_charge":3.39,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"GABAPENTIN TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462012701","type":"CDM"},{"code":"68462012701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ZONISAMIDE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462012901","type":"CDM"},{"code":"68462012901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CARVEDILOL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462016401","type":"CDM"},{"code":"68462016401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NAPROXEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462019001","type":"CDM"},{"code":"68462019001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462019590","type":"CDM"},{"code":"68462019590","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LAMOTRIGINE TAB CHEWABLE DISPERSIBLE 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462022801","type":"CDM"},{"code":"68462022801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462025501","type":"CDM"},{"code":"68462025501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462025901","type":"CDM"},{"code":"68462025901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462026290","type":"CDM"},{"code":"68462026290","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LINEZOLID TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462029113","type":"CDM"},{"code":"68462029113","type":"NDC"}],"standard_charges":[{"gross_charge":8.18,"discounted_cash":2.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462029201","type":"CDM"},{"code":"68462029201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462033090","type":"CDM"},{"code":"68462033090","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462033390","type":"CDM"},{"code":"68462033390","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NABUMETONE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462035801","type":"CDM"},{"code":"68462035801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"INDOMETHACIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462040601","type":"CDM"},{"code":"68462040601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OLMESARTAN MEDOXOMIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462043630","type":"CDM"},{"code":"68462043630","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RIZATRIPTAN BENZOATE ORAL DISINTEGRATING TAB 5 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462046740","type":"CDM"},{"code":"68462046740","type":"NDC"}],"standard_charges":[{"gross_charge":1.99,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"RIZATRIPTAN BENZOATE ORAL DISINTEGRATING TAB 10 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462046840","type":"CDM"},{"code":"68462046840","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.25 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462047830","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"68462047830","type":"NDC"}],"standard_charges":[{"gross_charge":206.34,"discounted_cash":72.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CLOBETASOL PROPIONATE SOLN 0.05%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx68462053228","type":"CDM"},{"code":"68462053228","type":"NDC"}],"standard_charges":[{"gross_charge":25.12,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MUPIROCIN CALCIUM CREAM 2%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx68462056417","type":"CDM"},{"code":"68462056417","type":"NDC"}],"standard_charges":[{"gross_charge":269.66,"discounted_cash":94.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MUPIROCIN CALCIUM CREAM 2%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx68462056435","type":"CDM"},{"code":"68462056435","type":"NDC"}],"standard_charges":[{"gross_charge":457.06,"discounted_cash":159.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SIROLIMUS TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462068201","type":"CDM"},{"code":"J7520","type":"HCPCS"},{"code":"68462068201","type":"NDC"}],"standard_charges":[{"gross_charge":3.07,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FACTOR IX COMPLEX FOR INJ 1000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68516320202","type":"CDM"},{"code":"J7194","type":"HCPCS"},{"code":"68516320202","type":"NDC"}],"standard_charges":[{"gross_charge":14482.38,"discounted_cash":5068.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 250 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68516460101","type":"CDM"},{"code":"J7186","type":"HCPCS"},{"code":"68516460101","type":"NDC"}],"standard_charges":[{"gross_charge":1965.04,"discounted_cash":687.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68516460201","type":"CDM"},{"code":"J7186","type":"HCPCS"},{"code":"68516460201","type":"NDC"}],"standard_charges":[{"gross_charge":3836.56,"discounted_cash":1342.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 1500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68516460402","type":"CDM"},{"code":"J7186","type":"HCPCS"},{"code":"68516460402","type":"NDC"}],"standard_charges":[{"gross_charge":16843.54,"discounted_cash":5895.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68516460601","type":"CDM"},{"code":"J7186","type":"HCPCS"},{"code":"68516460601","type":"NDC"}],"standard_charges":[{"gross_charge":4312.0,"discounted_cash":1509.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 2000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68516460902","type":"CDM"},{"code":"J7186","type":"HCPCS"},{"code":"68516460902","type":"NDC"}],"standard_charges":[{"gross_charge":15720.54,"discounted_cash":5502.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68516461201","type":"CDM"},{"code":"J7186","type":"HCPCS"},{"code":"68516461201","type":"NDC"}],"standard_charges":[{"gross_charge":4950.73,"discounted_cash":1732.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 1000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68516461302","type":"CDM"},{"code":"J7186","type":"HCPCS"},{"code":"68516461302","type":"NDC"}],"standard_charges":[{"gross_charge":9901.58,"discounted_cash":3465.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 1500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68516461402","type":"CDM"},{"code":"J7186","type":"HCPCS"},{"code":"68516461402","type":"NDC"}],"standard_charges":[{"gross_charge":14852.32,"discounted_cash":5198.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68516461701","type":"CDM"},{"code":"J7186","type":"HCPCS"},{"code":"68516461701","type":"NDC"}],"standard_charges":[{"gross_charge":4500.27,"discounted_cash":1575.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 1000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68516461802","type":"CDM"},{"code":"J7186","type":"HCPCS"},{"code":"68516461802","type":"NDC"}],"standard_charges":[{"gross_charge":9409.68,"discounted_cash":3293.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 1500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68516461902","type":"CDM"},{"code":"J7186","type":"HCPCS"},{"code":"68516461902","type":"NDC"}],"standard_charges":[{"gross_charge":14216.83,"discounted_cash":4975.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx68516521600","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"68516521600","type":"NDC"}],"standard_charges":[{"gross_charge":353.36,"discounted_cash":123.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx68516521602","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"68516521602","type":"NDC"}],"standard_charges":[{"gross_charge":707.84,"discounted_cash":247.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"RASAGILINE MESYLATE TAB 0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68546014256","type":"CDM"},{"code":"68546014256","type":"NDC"}],"standard_charges":[{"gross_charge":33.29,"discounted_cash":11.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ETHACRYNATE SODIUM FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68682001227","type":"CDM"},{"code":"J1807","type":"HCPCS"},{"code":"68682001227","type":"NDC"}],"standard_charges":[{"gross_charge":6884.97,"discounted_cash":2409.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68682010910","type":"CDM"},{"code":"68682010910","type":"NDC"}],"standard_charges":[{"gross_charge":2.54,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BRINZOLAMIDE OPHTH SUSP 1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx68682046410","type":"CDM"},{"code":"68682046410","type":"NDC"}],"standard_charges":[{"gross_charge":211.86,"discounted_cash":74.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68682099498","type":"CDM"},{"code":"68682099498","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DAUNORUBICIN-CYTARABINE LIPOSOME FOR IV INJ 44-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68727074502","type":"CDM"},{"code":"J9153","type":"HCPCS"},{"code":"68727074502","type":"NDC"}],"standard_charges":[{"gross_charge":54625.5,"discounted_cash":19118.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.0375 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68968663708","type":"CDM"},{"code":"68968663708","type":"NDC"}],"standard_charges":[{"gross_charge":16.65,"discounted_cash":5.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx69097017348","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"69097017348","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx69097017353","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"69097017353","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69097031986","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"69097031986","type":"NDC"}],"standard_charges":[{"gross_charge":3.47,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69097031987","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"69097031987","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CINACALCET HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097041002","type":"CDM"},{"code":"69097041002","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CELECOXIB CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097042107","type":"CDM"},{"code":"69097042107","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NADOLOL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238112309","type":"CDM"},{"code":"69238112309","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238149001","type":"CDM"},{"code":"69238149001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUMETANIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238149101","type":"CDM"},{"code":"69238149101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OFLOXACIN OTIC SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx69238161503","type":"CDM"},{"code":"69238161503","type":"NDC"}],"standard_charges":[{"gross_charge":20.62,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238165601","type":"CDM"},{"code":"69238165601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"IPRATROPIUM BROMIDE NASAL SOLN 0.06% (42 MCG/SPRAY)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx69238201702","type":"CDM"},{"code":"69238201702","type":"NDC"}],"standard_charges":[{"gross_charge":47.04,"discounted_cash":16.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69292053201","type":"CDM"},{"code":"69292053201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLURBIPROFEN SODIUM OPHTH SOLN 0.03%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx69292072225","type":"CDM"},{"code":"69292072225","type":"NDC"}],"standard_charges":[{"gross_charge":49.5,"discounted_cash":17.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315013601","type":"CDM"},{"code":"69315013601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CIPROFLOXACIN HCL OPHTH SOLN 0.3% (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx69315030802","type":"CDM"},{"code":"69315030802","type":"NDC"}],"standard_charges":[{"gross_charge":7.27,"discounted_cash":2.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROCORTISONE PERIANAL CREAM 2.5%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx69315031228","type":"CDM"},{"code":"69315031228","type":"NDC"}],"standard_charges":[{"gross_charge":10.96,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69367020301","type":"CDM"},{"code":"69367020301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDROCORTISONE ACETATE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69367024312","type":"CDM"},{"code":"69367024312","type":"NDC"}],"standard_charges":[{"gross_charge":16.08,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69367025409","type":"CDM"},{"code":"69367025409","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LACOSAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69367034860","type":"CDM"},{"code":"69367034860","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69367038901","type":"CDM"},{"code":"69367038901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.5% (5 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx69374033005","type":"CDM"},{"code":"J7611","type":"HCPCS"},{"code":"69374033005","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE SOLN PREF SYR 3 MG/3ML (1 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx69374093203","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"69374093203","type":"NDC"}],"standard_charges":[{"gross_charge":96.5,"discounted_cash":33.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PARICALCITOL CAP 1 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69387010330","type":"CDM"},{"code":"69387010330","type":"NDC"}],"standard_charges":[{"gross_charge":5.84,"discounted_cash":2.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"POT PHOS MONOBASIC W/SOD PHOS DI & MONOBAS TAB 155-852-130MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69543026810","type":"CDM"},{"code":"69543026810","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.3333333333333333333,"type":"ML"},"code_information":[{"code":"Rx69543038625","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"69543038625","type":"NDC"}],"standard_charges":[{"gross_charge":93.94,"discounted_cash":32.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69918073110","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"69918073110","type":"NDC"}],"standard_charges":[{"gross_charge":472.99,"discounted_cash":165.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NITROGLYCERIN TL SOLN 0.4 MG/SPRAY (400 MCG/SPRAY)","drug_information":{"unit":4.9,"type":"GM"},"code_information":[{"code":"Rx70003030065","type":"CDM"},{"code":"70003030065","type":"NDC"}],"standard_charges":[{"gross_charge":150.6,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METFORMIN HCL TAB 850 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010006401","type":"CDM"},{"code":"70010006401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METFORMIN HCL TAB 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010006509","type":"CDM"},{"code":"70010006509","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NAPROXEN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010013701","type":"CDM"},{"code":"70010013701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NAPROXEN TAB 375 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010013801","type":"CDM"},{"code":"70010013801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NAPROXEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010013901","type":"CDM"},{"code":"70010013901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70069001101","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"70069001101","type":"NDC"}],"standard_charges":[{"gross_charge":94.32,"discounted_cash":33.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx70069002125","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"70069002125","type":"NDC"}],"standard_charges":[{"gross_charge":2.19,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"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: JVCPCT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069006401","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"70069006401","type":"NDC"}],"standard_charges":[{"gross_charge":93.8,"discounted_cash":32.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHOCARBAMOL INJ 1000 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70069010105","type":"CDM"},{"code":"J2800","type":"HCPCS"},{"code":"70069010105","type":"NDC"}],"standard_charges":[{"gross_charge":97.76,"discounted_cash":34.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TOBRAMYCIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069013101","type":"CDM"},{"code":"70069013101","type":"NDC"}],"standard_charges":[{"gross_charge":6.87,"discounted_cash":2.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70069026101","type":"CDM"},{"code":"70069026101","type":"NDC"}],"standard_charges":[{"gross_charge":118.83,"discounted_cash":41.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70069027105","type":"CDM"},{"code":"70069027105","type":"NDC"}],"standard_charges":[{"gross_charge":94.57,"discounted_cash":33.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM IV SOLN 400-80 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069036110","type":"CDM"},{"code":"J2865","type":"HCPCS"},{"code":"70069036110","type":"NDC"}],"standard_charges":[{"gross_charge":95.48,"discounted_cash":33.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DICYCLOMINE HCL INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70069043101","type":"CDM"},{"code":"J0500","type":"HCPCS"},{"code":"70069043101","type":"NDC"}],"standard_charges":[{"gross_charge":96.91,"discounted_cash":33.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DICYCLOMINE HCL INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70069044101","type":"CDM"},{"code":"J0500","type":"HCPCS"},{"code":"70069044101","type":"NDC"}],"standard_charges":[{"gross_charge":185.3,"discounted_cash":64.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DICYCLOMINE HCL INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70069044105","type":"CDM"},{"code":"J0500","type":"HCPCS"},{"code":"70069044105","type":"NDC"}],"standard_charges":[{"gross_charge":185.36,"discounted_cash":64.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx70069064101","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"70069064101","type":"NDC"}],"standard_charges":[{"gross_charge":97.61,"discounted_cash":34.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 0.9% IV SOLN 30 UNIT/500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx70092106807","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"70092106807","type":"NDC"}],"standard_charges":[{"gross_charge":249.5,"discounted_cash":87.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENTANYL CITRATE-NACL 0.9% IV SOLN 2.5 MG/250ML,FENTANYL CITRATE-NACL PF 0.9% IV SOLN 1 MG/100 ML (10 MCG/ML),FENTANYL CITRATE-NACL 0.9% INJ SOLN 1 MG/100ML,FENTANYL CITRATE-NACL 0.9% INJ SOLN 2.5 MG/250ML,FENTANYL CITRATE IV SOLN 1000 MCG/100ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx70092109337","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"70092109337","type":"NDC"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":116.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENTANYL 0.2 MG/100ML-BUPIV 0.125%-NACL 0.9% EPIDURAL INJ,FENTANYL-BUPIVACAINE 2 MCG-0.125 %,FENTANYL 0.5 MG/250ML-BUPIV 0.125%-NACL 0.9% EPIDURAL INJ,FENTANYL 0.1 MG/50ML-BUPIV 0.125%-NACL 0.9% EPIDURAL SYR,FENTANYL CITRATE 2 MCG/ML-BUPIVACAINE 0.125% EPIDURAL INJ","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx70092110537","type":"CDM"},{"code":"70092110537","type":"NDC"}],"standard_charges":[{"gross_charge":221.4,"discounted_cash":77.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":30.0,"type":"ML"},"code_information":[{"code":"Rx70092129349","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"70092129349","type":"NDC"}],"standard_charges":[{"gross_charge":217.92,"discounted_cash":76.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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":"Rx70092150037","type":"CDM"},{"code":"70092150037","type":"NDC"}],"standard_charges":[{"gross_charge":323.7,"discounted_cash":113.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 0.9% IV SOLN 30 UNIT/500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx70092155207","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"70092155207","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70095002401","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"70095002401","type":"NDC"}],"standard_charges":[{"gross_charge":95.01,"discounted_cash":33.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"INDOCYANINE GREEN FOR INJ SOLN 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70100072501","type":"CDM"},{"code":"70100072501","type":"NDC"}],"standard_charges":[{"gross_charge":3094.95,"discounted_cash":1083.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 75 MG/100ML (0.75 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70121100301","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"70121100301","type":"NDC"}],"standard_charges":[{"gross_charge":3080.0,"discounted_cash":1078.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70121138907","type":"CDM"},{"code":"70121138907","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FILGRASTIM-AYOW SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx70121157001","type":"CDM"},{"code":"Q5125","type":"HCPCS"},{"code":"70121157001","type":"NDC"}],"standard_charges":[{"gross_charge":1678.54,"discounted_cash":587.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 40 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70121157305","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"70121157305","type":"NDC"}],"standard_charges":[{"gross_charge":95.45,"discounted_cash":33.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70121160407","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"70121160407","type":"NDC"}],"standard_charges":[{"gross_charge":767.83,"discounted_cash":268.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70121163705","type":"CDM"},{"code":"70121163705","type":"NDC"}],"standard_charges":[{"gross_charge":94.02,"discounted_cash":32.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx70121170501","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"70121170501","type":"NDC"}],"standard_charges":[{"gross_charge":98.75,"discounted_cash":34.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx70121170507","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"70121170507","type":"NDC"}],"standard_charges":[{"gross_charge":98.51,"discounted_cash":34.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70121173309","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"70121173309","type":"NDC"}],"standard_charges":[{"gross_charge":93.94,"discounted_cash":32.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VITAMIN A INJ 15 MG/ML (50000 UNIT/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70199002611","type":"CDM"},{"code":"70199002611","type":"NDC"}],"standard_charges":[{"gross_charge":3594.24,"discounted_cash":1257.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN (HUMAN) INJ SOLN 312 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70257005251","type":"CDM"},{"code":"J1573","type":"HCPCS"},{"code":"70257005251","type":"NDC"}],"standard_charges":[{"gross_charge":1344.0,"discounted_cash":470.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TACROLIMUS CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70377001511","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"70377001511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 75 MG/100ML (0.75 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70436016380","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"70436016380","type":"NDC"}],"standard_charges":[{"gross_charge":610.4,"discounted_cash":213.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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":"Rx70461002403","type":"CDM"},{"code":"90653","type":"HCPCS"},{"code":"70461002403","type":"NDC"}],"standard_charges":[{"gross_charge":793.3,"discounted_cash":277.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"INFLUENZA VAC TYPE A&B SURFACE ANT ADJ QUAD PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70461012303","type":"CDM"},{"code":"90694","type":"HCPCS"},{"code":"70461012303","type":"NDC"}],"standard_charges":[{"gross_charge":735.16,"discounted_cash":257.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DIGOXIN INJ 0.1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70515026210","type":"CDM"},{"code":"J1160","type":"HCPCS"},{"code":"70515026210","type":"NDC"}],"standard_charges":[{"gross_charge":1413.92,"discounted_cash":494.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL IV SOLN 1000 MG/200ML (BASE EQUIVALENT)","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx70594004201","type":"CDM"},{"code":"J3375","type":"HCPCS"},{"code":"70594004201","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL IV SOLN 1000 MG/200ML (BASE EQUIVALENT)","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx70594004203","type":"CDM"},{"code":"J3375","type":"HCPCS"},{"code":"70594004203","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL IV SOLN 1500 MG/300ML (BASE EQUIVALENT)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx70594004301","type":"CDM"},{"code":"J3372","type":"HCPCS"},{"code":"70594004301","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL IV SOLN 1500 MG/300ML (BASE EQUIVALENT)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx70594004302","type":"CDM"},{"code":"J3372","type":"HCPCS"},{"code":"70594004302","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL IV SOLN 1250 MG/250ML (BASE EQUIVALENT)","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx70594005702","type":"CDM"},{"code":"J3372","type":"HCPCS"},{"code":"70594005702","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CEFEPIME HCL FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594009002","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"70594009002","type":"NDC"}],"standard_charges":[{"gross_charge":102.24,"discounted_cash":35.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70700016525","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"70700016525","type":"NDC"}],"standard_charges":[{"gross_charge":93.63,"discounted_cash":32.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 2.5 GM/50ML (50 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx70700018822","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"70700018822","type":"NDC"}],"standard_charges":[{"gross_charge":286.7,"discounted_cash":100.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70700031527","type":"CDM"},{"code":"J1050","type":"HCPCS"},{"code":"70700031527","type":"NDC"}],"standard_charges":[{"gross_charge":101.26,"discounted_cash":35.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710101002","type":"CDM"},{"code":"70710101002","type":"NDC"}],"standard_charges":[{"gross_charge":2.64,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70710164307","type":"CDM"},{"code":"70710164307","type":"NDC"}],"standard_charges":[{"gross_charge":94.65,"discounted_cash":33.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70710198801","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"70710198801","type":"NDC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":33.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70710198807","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"70710198807","type":"NDC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":33.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIDOCAINE OINT 5%","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx70752011304","type":"CDM"},{"code":"70752011304","type":"NDC"}],"standard_charges":[{"gross_charge":22.2,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PROMETHAZINE HCL ORAL SOLN 6.25 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70752013812","type":"CDM"},{"code":"Q0169","type":"HCPCS"},{"code":"70752013812","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756004911","type":"CDM"},{"code":"70756004911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DOXEPIN HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756042511","type":"CDM"},{"code":"70756042511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756060525","type":"CDM"},{"code":"70756060525","type":"NDC"}],"standard_charges":[{"gross_charge":94.45,"discounted_cash":33.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064082","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"70756064082","type":"NDC"}],"standard_charges":[{"gross_charge":93.83,"discounted_cash":32.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064425","type":"CDM"},{"code":"70756064425","type":"NDC"}],"standard_charges":[{"gross_charge":93.78,"discounted_cash":32.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 2.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx70756064935","type":"CDM"},{"code":"70756064935","type":"NDC"}],"standard_charges":[{"gross_charge":71.01,"discounted_cash":24.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70860010010","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"70860010010","type":"NDC"}],"standard_charges":[{"gross_charge":95.92,"discounted_cash":33.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PACLITAXEL IV CONC 30 MG/5ML (6 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70860020005","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"70860020005","type":"NDC"}],"standard_charges":[{"gross_charge":286.5,"discounted_cash":100.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PACLITAXEL IV CONC 100 MG/16.7ML (6 MG/ML)","drug_information":{"unit":16.7,"type":"ML"},"code_information":[{"code":"Rx70860020017","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"70860020017","type":"NDC"}],"standard_charges":[{"gross_charge":270.29,"discounted_cash":94.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DECITABINE FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70860021920","type":"CDM"},{"code":"J0894","type":"HCPCS"},{"code":"70860021920","type":"NDC"}],"standard_charges":[{"gross_charge":1992.28,"discounted_cash":697.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70860040010","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"70860040010","type":"NDC"}],"standard_charges":[{"gross_charge":96.95,"discounted_cash":33.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"},{"gross_charge":5.55,"discounted_cash":1.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70860040041","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"70860040041","type":"NDC"}],"standard_charges":[{"gross_charge":5.56,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"},{"gross_charge":96.96,"discounted_cash":33.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 15 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70860070001","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"70860070001","type":"NDC"}],"standard_charges":[{"gross_charge":94.92,"discounted_cash":33.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 15 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70860070002","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"70860070002","type":"NDC"}],"standard_charges":[{"gross_charge":94.9,"discounted_cash":33.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.3333333333333333333,"type":"ML"},"code_information":[{"code":"Rx70860070101","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"70860070101","type":"NDC"}],"standard_charges":[{"gross_charge":93.51,"discounted_cash":32.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70860077602","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"70860077602","type":"NDC"}],"standard_charges":[{"gross_charge":93.77,"discounted_cash":32.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"TERBUTALINE SULFATE INJ 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70860080101","type":"CDM"},{"code":"J3105","type":"HCPCS"},{"code":"70860080101","type":"NDC"}],"standard_charges":[{"gross_charge":93.66,"discounted_cash":32.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PRAZOSIN HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954002010","type":"CDM"},{"code":"70954002010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PREDNISONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954006110","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"70954006110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LEVOCARNITINE ORAL SOLN 1 GM/10ML (10%)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx70954013910","type":"CDM"},{"code":"70954013910","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DIGOXIN TAB 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954020210","type":"CDM"},{"code":"70954020210","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"CARBAMAZEPINE SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70954024010","type":"CDM"},{"code":"70954024010","type":"NDC"}],"standard_charges":[{"gross_charge":2.19,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MISOPROSTOL TAB 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954044410","type":"CDM"},{"code":"70954044410","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ESTRADIOL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954056510","type":"CDM"},{"code":"70954056510","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71093011204","type":"CDM"},{"code":"71093011204","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FENTANYL CITRATE-NACL 0.9% IV SOLN 2.5 MG/250ML,FENTANYL CITRATE-NACL PF 0.9% IV SOLN 1 MG/100 ML (10 MCG/ML),FENTANYL CITRATE-NACL 0.9% INJ SOLN 1 MG/100ML,FENTANYL CITRATE-NACL 0.9% INJ SOLN 2.5 MG/250ML,FENTANYL CITRATE IV SOLN 1000 MCG/100ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx71266501001","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"71266501001","type":"NDC"}],"standard_charges":[{"gross_charge":407.4,"discounted_cash":142.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 0.9% IV SOLN 30 UNIT/500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx71266510301","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"71266510301","type":"NDC"}],"standard_charges":[{"gross_charge":250.5,"discounted_cash":87.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETAMINE HCL SOLN PREF SYR 50 MG/5ML (10 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71266908002","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"71266908002","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETAMINE HCL SOLN PREF SYR 50 MG/5ML (10 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71266908004","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"71266908004","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMINO ACID INFUSION 3% IN D10W","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx71285040401","type":"CDM"},{"code":"71285040401","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 0.9% IV SOLN 30 UNIT/500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx71285604401","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"71285604401","type":"NDC"}],"standard_charges":[{"gross_charge":249.5,"discounted_cash":87.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARDIOPLEGIC SOLN W/ LIDOCAINE","drug_information":{"unit":1052.8,"type":"ML"},"code_information":[{"code":"Rx71285900501","type":"CDM"},{"code":"71285900501","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 100 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx71288010120","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"71288010120","type":"NDC"}],"standard_charges":[{"gross_charge":238.85,"discounted_cash":83.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GEMCITABINE HCL INJ 1 GM/26.3ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":26.3,"type":"ML"},"code_information":[{"code":"Rx71288011728","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"71288011728","type":"NDC"}],"standard_charges":[{"gross_charge":223.6,"discounted_cash":78.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288013850","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"71288013850","type":"NDC"}],"standard_charges":[{"gross_charge":1513.85,"discounted_cash":529.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288016120","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"71288016120","type":"NDC"}],"standard_charges":[{"gross_charge":288.5,"discounted_cash":100.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PEMETREXED DISODIUM FOR IV SOLN 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288016795","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"71288016795","type":"NDC"}],"standard_charges":[{"gross_charge":632.09,"discounted_cash":221.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 10 MG/10ML (BASE EQUIVALENT)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx71288020011","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"71288020011","type":"NDC"}],"standard_charges":[{"gross_charge":96.37,"discounted_cash":33.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288020310","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"71288020310","type":"NDC"}],"standard_charges":[{"gross_charge":93.43,"discounted_cash":32.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288040210","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040210","type":"NDC"}],"standard_charges":[{"gross_charge":93.69,"discounted_cash":32.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PALONOSETRON HCL IV SOLN 0.25 MG/5ML (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx71288040905","type":"CDM"},{"code":"J2469","type":"HCPCS"},{"code":"71288040905","type":"NDC"}],"standard_charges":[{"gross_charge":94.94,"discounted_cash":33.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71288041085","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288041085","type":"NDC"}],"standard_charges":[{"gross_charge":96.69,"discounted_cash":33.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx71288041087","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288041087","type":"NDC"}],"standard_charges":[{"gross_charge":98.21,"discounted_cash":34.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx71288041089","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288041089","type":"NDC"}],"standard_charges":[{"gross_charge":99.64,"discounted_cash":34.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx71288043587","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043587","type":"NDC"}],"standard_charges":[{"gross_charge":99.27,"discounted_cash":34.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.8666666666666666667,"type":"ML"},"code_information":[{"code":"Rx71288043893","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043893","type":"NDC"}],"standard_charges":[{"gross_charge":203.12,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288050503","type":"CDM"},{"code":"71288050503","type":"NDC"}],"standard_charges":[{"gross_charge":94.98,"discounted_cash":33.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CISATRACURIUM BESYLATE (PF) IV SOLN 10 MG/5ML (2 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288071206","type":"CDM"},{"code":"71288071206","type":"NDC"}],"standard_charges":[{"gross_charge":93.71,"discounted_cash":32.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"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: JVCPCT LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL HCL FOR IV SOLN 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288080320","type":"CDM"},{"code":"J7519","type":"HCPCS"},{"code":"71288080320","type":"NDC"}],"standard_charges":[{"gross_charge":750.2,"discounted_cash":262.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BUPIVACAINE 0.75% IN DEXTROSE INJ 8.25%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71351002210","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"71351002210","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"PHENYLEPHRINE HCL (PF) IV SOLN 0.5 MG/5ML (100 MCG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71863020206","type":"CDM"},{"code":"J2372","type":"HCPCS"},{"code":"71863020206","type":"NDC"}],"standard_charges":[{"gross_charge":93.97,"discounted_cash":32.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"QUINIDINE GLUCONATE TAB ER 324 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71930001612","type":"CDM"},{"code":"71930001612","type":"NDC"}],"standard_charges":[{"gross_charge":10.05,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EMOLLIENT - OINTMENT","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx72140000375","type":"CDM"},{"code":"72140000375","type":"NDC"}],"standard_charges":[{"gross_charge":9.37,"discounted_cash":3.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CARDIOPLEGIC SOLN W/ LIDOCAINE","drug_information":{"unit":1052.8,"type":"ML"},"code_information":[{"code":"Rx72196020201","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"72196020201","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMINO ACID INFUSION 3% IN D10W","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx72196040401","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"72196040401","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 0.9% IV SOLN 30 UNIT/500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx72196604401","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"72196604401","type":"NDC"}],"standard_charges":[{"gross_charge":249.5,"discounted_cash":87.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL-SODIUM CHLORIDE IV SOLN 1 GM/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx72196606401","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"72196606401","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL-SODIUM CHLORIDE IV SOLN 1.25 GM/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx72196607401","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"72196607401","type":"NDC"}],"standard_charges":[{"gross_charge":246.5,"discounted_cash":86.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DECITABINE FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205003601","type":"CDM"},{"code":"J0894","type":"HCPCS"},{"code":"72205003601","type":"NDC"}],"standard_charges":[{"gross_charge":1972.61,"discounted_cash":690.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FOSAPREPITANT DIMEGLUMINE FOR IV INFUSION 150 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205005401","type":"CDM"},{"code":"J1453","type":"HCPCS"},{"code":"72205005401","type":"NDC"}],"standard_charges":[{"gross_charge":160.16,"discounted_cash":56.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx72205012007","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"72205012007","type":"NDC"}],"standard_charges":[{"gross_charge":94.46,"discounted_cash":33.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ACYCLOVIR SUSP 200 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx72205017072","type":"CDM"},{"code":"72205017072","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ARSENIC TRIOXIDE IV SOLN 10 MG/10ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx72205017101","type":"CDM"},{"code":"J9017","type":"HCPCS"},{"code":"72205017101","type":"NDC"}],"standard_charges":[{"gross_charge":330.72,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx72205022007","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"72205022007","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 24-26 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205028018","type":"CDM"},{"code":"72205028018","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx72266010201","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"72266010201","type":"NDC"}],"standard_charges":[{"gross_charge":93.48,"discounted_cash":32.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx72266010301","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"72266010301","type":"NDC"}],"standard_charges":[{"gross_charge":93.46,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.3333333333333333333,"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: JVCPCT LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72266012325","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"72266012325","type":"NDC"}],"standard_charges":[{"gross_charge":93.72,"discounted_cash":32.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ONDANSETRON HCL INJ 40 MG/20ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72266012401","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"72266012401","type":"NDC"}],"standard_charges":[{"gross_charge":93.67,"discounted_cash":32.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BROMFENAC SODIUM OPHTH SOLN 0.09% (BASE EQUIV) (ONCE-DAILY)","drug_information":{"unit":1.7,"type":"ML"},"code_information":[{"code":"Rx72266014201","type":"CDM"},{"code":"72266014201","type":"NDC"}],"standard_charges":[{"gross_charge":149.86,"discounted_cash":52.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 50 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx72266016101","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"72266016101","type":"NDC"}],"standard_charges":[{"gross_charge":285.94,"discounted_cash":100.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CALCITRIOL INJ 1 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx72266025110","type":"CDM"},{"code":"J0636","type":"HCPCS"},{"code":"72266025110","type":"NDC"}],"standard_charges":[{"gross_charge":95.41,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72485011310","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"72485011310","type":"NDC"}],"standard_charges":[{"gross_charge":132.37,"discounted_cash":46.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx72485040401","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"72485040401","type":"NDC"}],"standard_charges":[{"gross_charge":96.57,"discounted_cash":33.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ERYTHROMYCIN OPHTH OINT 5 MG/GM","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx72485067031","type":"CDM"},{"code":"72485067031","type":"NDC"}],"standard_charges":[{"gross_charge":9.38,"discounted_cash":3.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MITOMYCIN FOR PYELOCALYCEAL SOLN 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72493010303","type":"CDM"},{"code":"J9281","type":"HCPCS"},{"code":"72493010303","type":"NDC"}],"standard_charges":[{"gross_charge":106345.6,"discounted_cash":37220.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CAPSAICIN PATCH 8% & CLEANSING GEL KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72512092901","type":"CDM"},{"code":"J7336","type":"HCPCS"},{"code":"72512092901","type":"NDC"}],"standard_charges":[{"gross_charge":1355.84,"discounted_cash":474.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":6.7,"type":"GM"},"code_information":[{"code":"Rx72572001401","type":"CDM"},{"code":"72572001401","type":"NDC"}],"standard_charges":[{"gross_charge":28.21,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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":"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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572017110","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"72572017110","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572032110","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"72572032110","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx72572038001","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"72572038001","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx72572047010","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"72572047010","type":"NDC"}],"standard_charges":[{"gross_charge":214.36,"discounted_cash":75.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572055001","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"72572055001","type":"NDC"}],"standard_charges":[{"gross_charge":96.05,"discounted_cash":33.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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":"Rx72572057301","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"72572057301","type":"NDC"}],"standard_charges":[{"gross_charge":97.34,"discounted_cash":34.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx72572074001","type":"CDM"},{"code":"72572074001","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 10 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572080501","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"72572080501","type":"NDC"}],"standard_charges":[{"gross_charge":365.68,"discounted_cash":127.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72578000801","type":"CDM"},{"code":"72578000801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 15 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72611071925","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"72611071925","type":"NDC"}],"standard_charges":[{"gross_charge":94.17,"discounted_cash":32.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.3333333333333333333,"type":"ML"},"code_information":[{"code":"Rx72611072225","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"72611072225","type":"NDC"}],"standard_charges":[{"gross_charge":93.54,"discounted_cash":32.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72819015295","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"72819015295","type":"NDC"}],"standard_charges":[{"gross_charge":616.72,"discounted_cash":215.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72888001401","type":"CDM"},{"code":"72888001401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMIODARONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72888006030","type":"CDM"},{"code":"72888006030","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72888006701","type":"CDM"},{"code":"72888006701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72888006801","type":"CDM"},{"code":"72888006801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72888006901","type":"CDM"},{"code":"72888006901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72888008401","type":"CDM"},{"code":"72888008401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"GABAPENTIN ORAL SOLN 250 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72888010425","type":"CDM"},{"code":"72888010425","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"INSULIN ASPART INJ SOLN 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx73070010011","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"73070010011","type":"NDC"}],"standard_charges":[{"gross_charge":574.47,"discounted_cash":201.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx73293000101","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"73293000101","type":"NDC"}],"standard_charges":[{"gross_charge":93.71,"discounted_cash":32.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) TAB 10440-39150-39150 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx73562010410","type":"CDM"},{"code":"73562010410","type":"NDC"}],"standard_charges":[{"gross_charge":5.81,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 5000-17000-24000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx73562011501","type":"CDM"},{"code":"73562011501","type":"NDC"}],"standard_charges":[{"gross_charge":2.92,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"AMIODARONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75907000530","type":"CDM"},{"code":"75907000530","type":"NDC"}],"standard_charges":[{"gross_charge":3.83,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx76014000525","type":"CDM"},{"code":"76014000525","type":"NDC"}],"standard_charges":[{"gross_charge":94.26,"discounted_cash":32.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx76045000401","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"76045000401","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE INJ 4 MG/ML,MORPHINE SULFATE INJ PF 4 MG/ML,MORPHINE SULFATE IV SOLN PF 4 MG/ML,MORPHINE SULFATE IV SOLN 4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx76045000510","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"76045000510","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MORPHINE SULFATE INJ 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx76045000511","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"76045000511","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76045000996","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000996","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE SOLN PREF SYR 3 MG/3ML (1 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx76045021430","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"76045021430","type":"NDC"}],"standard_charges":[{"gross_charge":94.64,"discounted_cash":33.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE SOLN PREF SYR 3 MG/3ML (1 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx76045038313","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"76045038313","type":"NDC"}],"standard_charges":[{"gross_charge":94.79,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE SOLN PREF SYR 3 MG/3ML (1 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx76045038330","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"76045038330","type":"NDC"}],"standard_charges":[{"gross_charge":94.59,"discounted_cash":33.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"NOREPINEPHRINE-DEXTROSE IV SOLUTION 4 MG/250ML-5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx76154047115","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"76154047115","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 4 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx76154047415","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"76154047415","type":"NDC"}],"standard_charges":[{"gross_charge":243.6,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 1.25 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204001101","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"76204001101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"IPRATROPIUM BROMIDE INHAL SOLN 0.02%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx76204010001","type":"CDM"},{"code":"J7644","type":"HCPCS"},{"code":"76204010001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx76204020001","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"76204020001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx76297000102","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"76297000102","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx76297000111","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"76297000111","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx76297000121","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"76297000121","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"FOSCARNET SODIUM INJ 6000 MG/250ML (24 MG/ML)","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx76310002425","type":"CDM"},{"code":"J1455","type":"HCPCS"},{"code":"76310002425","type":"NDC"}],"standard_charges":[{"gross_charge":3419.1,"discounted_cash":1196.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx76329301505","type":"CDM"},{"code":"76329301505","type":"NDC"}],"standard_charges":[{"gross_charge":16.71,"discounted_cash":5.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx76329330101","type":"CDM"},{"code":"76329330101","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx76329330201","type":"CDM"},{"code":"76329330201","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"DESLORATADINE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx76439010710","type":"CDM"},{"code":"76439010710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"PENTOBARBITAL SODIUM INJ 50 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx76478050120","type":"CDM"},{"code":"J2515","type":"HCPCS"},{"code":"76478050120","type":"NDC"}],"standard_charges":[{"gross_charge":1311.04,"discounted_cash":458.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"MOMETASONE FUROATE INHAL POWD 220 MCG/ACT (BREATH ACTIVATED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx78206011404","type":"CDM"},{"code":"78206011404","type":"NDC"}],"standard_charges":[{"gross_charge":138.12,"discounted_cash":48.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"TRANEXAMIC ACID-SODIUM CHLORIDE IV SOLN 1000 MG/100ML-0.7%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx80830232902","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"80830232902","type":"NDC"}],"standard_charges":[{"gross_charge":246.4,"discounted_cash":86.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BRIMONIDINE TARTRATE OPHTH SOLN 0.15%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx82182077305","type":"CDM"},{"code":"82182077305","type":"NDC"}],"standard_charges":[{"gross_charge":119.92,"discounted_cash":41.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DICLOFENAC EPOLAMINE PATCH 1.3%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx82347040504","type":"CDM"},{"code":"82347040504","type":"NDC"}],"standard_charges":[{"gross_charge":7.77,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DICLOFENAC EPOLAMINE PATCH 1.3%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx82347040505","type":"CDM"},{"code":"82347040505","type":"NDC"}],"standard_charges":[{"gross_charge":6.78,"discounted_cash":2.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx82347050504","type":"CDM"},{"code":"82347050504","type":"NDC"}],"standard_charges":[{"gross_charge":3.97,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT LOCATION"}]},{"description":"BORTEZOMIB FOR INJ 3.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx83090000801","type":"CDM"},{"code":"J9041","type":"HCPCS"},{"code":"83090000801","type":"NDC"}],"standard_charges":[{"gross_charge":250.04,"discounted_cash":87.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 7%","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx83490030760","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"83490030760","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"DEHYDRATED ALCOHOL INTRA-ARTERIAL SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx83634030605","type":"CDM"},{"code":"83634030605","type":"NDC"}],"standard_charges":[{"gross_charge":718.82,"discounted_cash":251.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE FOR IV SOLN 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx83634040010","type":"CDM"},{"code":"J0583","type":"HCPCS"},{"code":"83634040010","type":"NDC"}],"standard_charges":[{"gross_charge":349.16,"discounted_cash":122.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx84769000202","type":"CDM"},{"code":"84769000202","type":"NDC"}],"standard_charges":[{"gross_charge":93.59,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 779930 = Hospital System Supply Identifier | 773375 = 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: JVCPCT LOCATION | 410428 = Hospital System Supply Identifier | 417181 = 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: JVCPCT 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: JVCPCT LOCATION | 408056 = Hospital System Supply Identifier | 245915 = 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: JVCPCT 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: JVCPCT LOCATION | 408053 = Hospital System Supply Identifier | 245912 = 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: JVCPCT LOCATION | 408052 = Hospital System Supply Identifier | 245911 = 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: JVCPCT LOCATION | 408055 = Hospital System Supply Identifier | 245914 = 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: JVCPCT LOCATION | 408050 = Hospital System Supply Identifier | 245909 = 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: JVCPCT LOCATION | 35037 = Hospital System Supply Identifier | 116023 = 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: JVCPCT LOCATION | 53562 = Hospital System Supply Identifier | 116024 = 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: JVCPCT LOCATION | 408051 = Hospital System Supply Identifier | 245910 = 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: JVCPCT LOCATION | 35272 = Hospital System Supply Identifier | 142730 = 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: JVCPCT 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: JVCPCT LOCATION | 407863 = Hospital System Supply Identifier | 206202 = 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: JVCPCT LOCATION | 407861 = Hospital System Supply Identifier | 206200 = 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: JVCPCT LOCATION | 407484 = Hospital System Supply Identifier | 147124 = 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: JVCPCT LOCATION | 407862 = Hospital System Supply Identifier | 206201 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 53560 = Hospital System Supply Identifier | 116020 = 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: JVCPCT LOCATION | 53559 = Hospital System Supply Identifier | 116019 = 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: JVCPCT LOCATION | 166634 = Hospital System Supply Identifier | 147123 = 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: JVCPCT LOCATION | 168151 = Hospital System Supply Identifier | 206183 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 168152 = Hospital System Supply Identifier | 206184 = 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: JVCPCT LOCATION | 168150 = Hospital System Supply Identifier | 206182 = 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: JVCPCT LOCATION | 166636 = Hospital System Supply Identifier | 147127 = 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: JVCPCT LOCATION | 166638 = Hospital System Supply Identifier | 147129 = 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: JVCPCT LOCATION | 166637 = Hospital System Supply Identifier | 147128 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 53561 = Hospital System Supply Identifier | 116021 = 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: JVCPCT LOCATION | 168149 = Hospital System Supply Identifier | 206181 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 407858 = Hospital System Supply Identifier | 206197 = 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: JVCPCT LOCATION | 407854 = Hospital System Supply Identifier | 206193 = 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: JVCPCT LOCATION | 407857 = Hospital System Supply Identifier | 206196 = 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: JVCPCT LOCATION | 407852 = Hospital System Supply Identifier | 206191 = 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: JVCPCT LOCATION | 407853 = Hospital System Supply Identifier | 206192 = 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: JVCPCT LOCATION | 407486 = Hospital System Supply Identifier | 147130 = 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: JVCPCT LOCATION | 407849 = Hospital System Supply Identifier | 206188 = 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: JVCPCT LOCATION | 407855 = Hospital System Supply Identifier | 206194 = 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: JVCPCT 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: JVCPCT LOCATION | 407850 = Hospital System Supply Identifier | 206189 = 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: JVCPCT LOCATION | 408762 = Hospital System Supply Identifier | 339794 = 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: JVCPCT LOCATION | 408751 = Hospital System Supply Identifier | 339783 = 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: JVCPCT LOCATION | 408752 = Hospital System Supply Identifier | 339784 = 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: JVCPCT LOCATION | 408753 = Hospital System Supply Identifier | 339785 = 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: JVCPCT LOCATION | 408754 = Hospital System Supply Identifier | 339786 = 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: JVCPCT 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: JVCPCT LOCATION | 408756 = Hospital System Supply Identifier | 339788 = 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: JVCPCT LOCATION | 408757 = Hospital System Supply Identifier | 339789 = 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: JVCPCT LOCATION | 408758 = Hospital System Supply Identifier | 339790 = 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: JVCPCT LOCATION | 408759 = Hospital System Supply Identifier | 339791 = 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: JVCPCT LOCATION | 408760 = Hospital System Supply Identifier | 339792 = 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: JVCPCT LOCATION | 408761 = Hospital System Supply Identifier | 339793 = 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: JVCPCT LOCATION | 1053827 = Hospital System Supply Identifier | 876277 = 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: JVCPCT LOCATION | 1053826 = Hospital System Supply Identifier | 876276 = 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: JVCPCT LOCATION | 1053825 = Hospital System Supply Identifier | 876275 = 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: JVCPCT 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: JVCPCT LOCATION | 1053829 = Hospital System Supply Identifier | 876279 = 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: JVCPCT LOCATION | 1053830 = Hospital System Supply Identifier | 876280 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 821235 = Hospital System Supply Identifier | S121105 = 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: JVCPCT 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: JVCPCT LOCATION | 932148 = Hospital System Supply Identifier | 816523 = 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: JVCPCT 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: JVCPCT LOCATION | 944916 = Hospital System Supply Identifier | 829511 = 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: JVCPCT LOCATION | 1053832 = Hospital System Supply Identifier | 876282 = 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: JVCPCT 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: JVCPCT LOCATION | 1053836 = Hospital System Supply Identifier | 876286 = 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: JVCPCT LOCATION | 1053834 = Hospital System Supply Identifier | 876284 = 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: JVCPCT 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: JVCPCT LOCATION | 1053833 = Hospital System Supply Identifier | 876283 = 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: JVCPCT LOCATION | 932146 = Hospital System Supply Identifier | 816521 = 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: JVCPCT 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: JVCPCT LOCATION | 1053838 = Hospital System Supply Identifier | 876288 = 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: JVCPCT LOCATION | 1053839 = Hospital System Supply Identifier | 876289 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 821257 = Hospital System Supply Identifier | S298652 = 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: JVCPCT LOCATION | 1053844 = Hospital System Supply Identifier | 876294 = 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: JVCPCT LOCATION | 1053842 = Hospital System Supply Identifier | 876292 = 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: JVCPCT LOCATION | 1053843 = Hospital System Supply Identifier | 876293 = 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: JVCPCT LOCATION | 1053845 = Hospital System Supply Identifier | 876295 = 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: JVCPCT LOCATION | 821258 = Hospital System Supply Identifier | S48755 = 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: JVCPCT LOCATION | 821259 = Hospital System Supply Identifier | S48756 = 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: JVCPCT LOCATION | 1053846 = Hospital System Supply Identifier | 876296 = 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: JVCPCT LOCATION | 1053847 = Hospital System Supply Identifier | 876297 = 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: JVCPCT LOCATION | 1053848 = Hospital System Supply Identifier | 876298 = 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: JVCPCT LOCATION | 932144 = Hospital System Supply Identifier | 816519 = 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: JVCPCT LOCATION | 1053849 = Hospital System Supply Identifier | 876299 = 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: JVCPCT LOCATION | 943270 = Hospital System Supply Identifier | 827839 = 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: JVCPCT LOCATION | 932142 = Hospital System Supply Identifier | 816517 = 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: JVCPCT LOCATION | 943269 = Hospital System Supply Identifier | 827838 = 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: JVCPCT 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: JVCPCT LOCATION | 932145 = Hospital System Supply Identifier | 816520 = 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: JVCPCT 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: JVCPCT LOCATION | 946351 = Hospital System Supply Identifier | 830987 = 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: JVCPCT LOCATION | 1053850 = Hospital System Supply Identifier | 876300 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1053853 = Hospital System Supply Identifier | 876303 = 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: JVCPCT LOCATION | 1053855 = Hospital System Supply Identifier | 876305 = 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: JVCPCT 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: JVCPCT LOCATION | 1053857 = Hospital System Supply Identifier | 876307 = 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: JVCPCT LOCATION | 1053854 = Hospital System Supply Identifier | 876304 = 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: JVCPCT LOCATION | 944990 = Hospital System Supply Identifier | 829587 = 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: JVCPCT LOCATION | 944991 = Hospital System Supply Identifier | 829588 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1053863 = Hospital System Supply Identifier | 876313 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1053866 = Hospital System Supply Identifier | 876316 = 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: JVCPCT LOCATION | 1053867 = Hospital System Supply Identifier | 876317 = 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: JVCPCT LOCATION | 1053868 = Hospital System Supply Identifier | 876318 = 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: JVCPCT LOCATION | 1053871 = Hospital System Supply Identifier | 876321 = 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: JVCPCT 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: JVCPCT LOCATION | 1053870 = Hospital System Supply Identifier | 876320 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1053877 = Hospital System Supply Identifier | 876327 = 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: JVCPCT LOCATION | 1053878 = Hospital System Supply Identifier | 876328 = 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: JVCPCT LOCATION | 1053879 = Hospital System Supply Identifier | 876329 = 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: JVCPCT LOCATION | 1053880 = Hospital System Supply Identifier | 876330 = 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: JVCPCT LOCATION | 1053881 = Hospital System Supply Identifier | 876331 = 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: JVCPCT LOCATION | 1053882 = Hospital System Supply Identifier | 876332 = 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: JVCPCT LOCATION | 1053883 = Hospital System Supply Identifier | 876333 = 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: JVCPCT LOCATION | 1053888 = Hospital System Supply Identifier | 876338 = 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: JVCPCT LOCATION | 1053887 = Hospital System Supply Identifier | 876337 = 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: JVCPCT LOCATION | 1053886 = Hospital System Supply Identifier | 876336 = 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: JVCPCT LOCATION | 1053885 = Hospital System Supply Identifier | 876335 = 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: JVCPCT LOCATION | 1053884 = Hospital System Supply Identifier | 876334 = 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: JVCPCT LOCATION | 1053889 = Hospital System Supply Identifier | 876339 = 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: JVCPCT LOCATION | 1053890 = Hospital System Supply Identifier | 876340 = 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: JVCPCT LOCATION | 1053891 = Hospital System Supply Identifier | 876341 = 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: JVCPCT LOCATION | 1053892 = Hospital System Supply Identifier | 876342 = 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: JVCPCT LOCATION | 1053893 = Hospital System Supply Identifier | 876343 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1053904 = Hospital System Supply Identifier | 876354 = 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: JVCPCT LOCATION | 1053902 = Hospital System Supply Identifier | 876352 = 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: JVCPCT LOCATION | 1053903 = Hospital System Supply Identifier | 876353 = 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: JVCPCT LOCATION | 1053900 = Hospital System Supply Identifier | 876350 = 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: JVCPCT LOCATION | 1053901 = Hospital System Supply Identifier | 876351 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1053909 = Hospital System Supply Identifier | 876359 = 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: JVCPCT LOCATION | 1053911 = Hospital System Supply Identifier | 876361 = 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: JVCPCT LOCATION | 1053910 = Hospital System Supply Identifier | 876360 = 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: JVCPCT LOCATION | 1053912 = Hospital System Supply Identifier | 876362 = 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: JVCPCT LOCATION | 1053913 = Hospital System Supply Identifier | 876363 = 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: JVCPCT LOCATION | 1053914 = Hospital System Supply Identifier | 876364 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1053934 = Hospital System Supply Identifier | 876384 = 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: JVCPCT 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: JVCPCT LOCATION | 1053935 = Hospital System Supply Identifier | 876385 = 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: JVCPCT 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: JVCPCT LOCATION | 818909 = Hospital System Supply Identifier | S48754 = 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: JVCPCT LOCATION | 1053937 = Hospital System Supply Identifier | 876387 = 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: JVCPCT LOCATION | 819260 = Hospital System Supply Identifier | S298651 = 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: JVCPCT LOCATION | 1053939 = Hospital System Supply Identifier | 876389 = 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: JVCPCT 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: JVCPCT LOCATION | 1053938 = Hospital System Supply Identifier | 876388 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1053944 = Hospital System Supply Identifier | 876394 = 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: JVCPCT LOCATION | 1053947 = Hospital System Supply Identifier | 876397 = 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: JVCPCT LOCATION | 1053946 = Hospital System Supply Identifier | 876396 = 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: JVCPCT LOCATION | 1053948 = Hospital System Supply Identifier | 876398 = 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: JVCPCT LOCATION | 945774 = Hospital System Supply Identifier | 830394 = 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: JVCPCT LOCATION | 1053945 = Hospital System Supply Identifier | 876395 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1053954 = Hospital System Supply Identifier | 876404 = 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: JVCPCT LOCATION | 1356942 = Hospital System Supply Identifier | 1082505 = 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: JVCPCT LOCATION | 1053955 = Hospital System Supply Identifier | 876405 = 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: JVCPCT 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: JVCPCT LOCATION | 1053956 = Hospital System Supply Identifier | 876406 = 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: JVCPCT LOCATION | 1053960 = Hospital System Supply Identifier | 876410 = 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: JVCPCT LOCATION | 1053959 = Hospital System Supply Identifier | 876409 = 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: JVCPCT LOCATION | 1053961 = Hospital System Supply Identifier | 876411 = 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: JVCPCT 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: JVCPCT LOCATION | 1053958 = Hospital System Supply Identifier | 876408 = 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: JVCPCT LOCATION | 971157 = Hospital System Supply Identifier | 841869 = 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: JVCPCT LOCATION | 1053962 = Hospital System Supply Identifier | 876412 = 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: JVCPCT LOCATION | 1053963 = Hospital System Supply Identifier | 876413 = 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: JVCPCT LOCATION | 821596 = Hospital System Supply Identifier | S298653 = 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: JVCPCT LOCATION | 821595 = Hospital System Supply Identifier | S298654 = 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: JVCPCT LOCATION | 1053966 = Hospital System Supply Identifier | 876416 = 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: JVCPCT LOCATION | 1053965 = Hospital System Supply Identifier | 876415 = 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: JVCPCT LOCATION | 1053964 = Hospital System Supply Identifier | 876414 = 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: JVCPCT 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: JVCPCT LOCATION | 939588 = Hospital System Supply Identifier | 824113 = 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: JVCPCT 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: JVCPCT LOCATION | 1053968 = Hospital System Supply Identifier | 876418 = 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: JVCPCT 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: JVCPCT LOCATION | 1053970 = Hospital System Supply Identifier | 876420 = 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: JVCPCT LOCATION | 1053971 = Hospital System Supply Identifier | 876421 = 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: JVCPCT 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: JVCPCT LOCATION | 1053973 = Hospital System Supply Identifier | 876423 = 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: JVCPCT LOCATION | 1053975 = Hospital System Supply Identifier | 876425 = 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: JVCPCT LOCATION | 1053974 = Hospital System Supply Identifier | 876424 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1053978 = Hospital System Supply Identifier | 876428 = 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: JVCPCT LOCATION | 1053979 = Hospital System Supply Identifier | 876429 = 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: JVCPCT 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: JVCPCT LOCATION | 1053981 = Hospital System Supply Identifier | 876431 = 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: JVCPCT LOCATION | 1053982 = Hospital System Supply Identifier | 876432 = 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: JVCPCT LOCATION | 1053983 = Hospital System Supply Identifier | 876433 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1053995 = Hospital System Supply Identifier | 876445 = 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: JVCPCT LOCATION | 971160 = Hospital System Supply Identifier | 841872 = 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: JVCPCT LOCATION | 971161 = Hospital System Supply Identifier | 841873 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054000 = Hospital System Supply Identifier | 876450 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054002 = Hospital System Supply Identifier | 876452 = 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: JVCPCT LOCATION | 1054005 = Hospital System Supply Identifier | 876455 = 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: JVCPCT LOCATION | 1054007 = Hospital System Supply Identifier | 876457 = 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: JVCPCT LOCATION | 1054006 = Hospital System Supply Identifier | 876456 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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":"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: JVCPCT LOCATION | 1356970 = Hospital System Supply Identifier | 1083593 = 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: JVCPCT 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":"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: JVCPCT LOCATION | 1356949 = Hospital System Supply Identifier | 1083628 = 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: JVCPCT LOCATION | 1356751 = Hospital System Supply Identifier | 1083689 = 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: JVCPCT 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: JVCPCT LOCATION | 1356385 = Hospital System Supply Identifier | 1083659 = 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: JVCPCT 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: JVCPCT LOCATION | 1356433 = Hospital System Supply Identifier | 1083733 = 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: JVCPCT 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: JVCPCT LOCATION | 1356837 = Hospital System Supply Identifier | 1083710 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054031 = Hospital System Supply Identifier | 876481 = 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: JVCPCT LOCATION | 1054032 = Hospital System Supply Identifier | 876482 = 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: JVCPCT LOCATION | 1054033 = Hospital System Supply Identifier | 876483 = 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: JVCPCT LOCATION | 1054034 = Hospital System Supply Identifier | 876484 = 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: JVCPCT LOCATION | 1054035 = Hospital System Supply Identifier | 876485 = 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: JVCPCT LOCATION | 1054036 = Hospital System Supply Identifier | 876486 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054041 = Hospital System Supply Identifier | 876491 = 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: JVCPCT LOCATION | 1054042 = Hospital System Supply Identifier | 876492 = 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: JVCPCT LOCATION | 1054043 = Hospital System Supply Identifier | 876493 = 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: JVCPCT 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: JVCPCT LOCATION | 1054045 = Hospital System Supply Identifier | 876495 = 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: JVCPCT LOCATION | 1054046 = Hospital System Supply Identifier | 876496 = 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: JVCPCT LOCATION | 1054051 = Hospital System Supply Identifier | 876501 = 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: JVCPCT LOCATION | 1054050 = Hospital System Supply Identifier | 876500 = 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: JVCPCT LOCATION | 1054049 = Hospital System Supply Identifier | 876499 = 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: JVCPCT LOCATION | 1054048 = Hospital System Supply Identifier | 876498 = 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: JVCPCT LOCATION | 1054047 = Hospital System Supply Identifier | 876497 = 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: JVCPCT LOCATION | 1054052 = Hospital System Supply Identifier | 876502 = 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: JVCPCT LOCATION | 1054053 = Hospital System Supply Identifier | 876503 = 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: JVCPCT LOCATION | 1054054 = Hospital System Supply Identifier | 876504 = 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: JVCPCT LOCATION | 1054055 = Hospital System Supply Identifier | 876505 = 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: JVCPCT LOCATION | 1054056 = Hospital System Supply Identifier | 876506 = 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: JVCPCT LOCATION | 1054058 = Hospital System Supply Identifier | 876508 = 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: JVCPCT LOCATION | 1054057 = Hospital System Supply Identifier | 876507 = 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: JVCPCT 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: JVCPCT LOCATION | 1054060 = Hospital System Supply Identifier | 876510 = 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: JVCPCT 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: JVCPCT LOCATION | 1054062 = Hospital System Supply Identifier | 876512 = 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: JVCPCT LOCATION | 1054063 = Hospital System Supply Identifier | 876513 = 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: JVCPCT LOCATION | 1054064 = Hospital System Supply Identifier | 876514 = 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: JVCPCT LOCATION | 1054065 = Hospital System Supply Identifier | 876515 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054083 = Hospital System Supply Identifier | 876533 = 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: JVCPCT LOCATION | 1054086 = Hospital System Supply Identifier | 876536 = 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: JVCPCT LOCATION | 1054084 = Hospital System Supply Identifier | 876534 = 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: JVCPCT LOCATION | 1054085 = Hospital System Supply Identifier | 876535 = 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: JVCPCT LOCATION | 1054087 = Hospital System Supply Identifier | 876537 = 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: JVCPCT LOCATION | 1054088 = Hospital System Supply Identifier | 876538 = 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: JVCPCT 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: JVCPCT LOCATION | 1054091 = Hospital System Supply Identifier | 876541 = 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: JVCPCT LOCATION | 1054089 = Hospital System Supply Identifier | 876539 = 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: JVCPCT LOCATION | 1054092 = Hospital System Supply Identifier | 876542 = 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: JVCPCT LOCATION | 1054094 = Hospital System Supply Identifier | 876544 = 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: JVCPCT LOCATION | 1054093 = Hospital System Supply Identifier | 876543 = 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: JVCPCT LOCATION | 1054095 = Hospital System Supply Identifier | 876545 = 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: JVCPCT LOCATION | 1054096 = Hospital System Supply Identifier | 876546 = 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: JVCPCT LOCATION | 1054097 = Hospital System Supply Identifier | 876547 = 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: JVCPCT LOCATION | 1054101 = Hospital System Supply Identifier | 876551 = 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: JVCPCT LOCATION | 1054100 = Hospital System Supply Identifier | 876550 = 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: JVCPCT LOCATION | 1054102 = Hospital System Supply Identifier | 876552 = 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: JVCPCT 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: JVCPCT LOCATION | 1054099 = Hospital System Supply Identifier | 876549 = 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: JVCPCT LOCATION | 1054103 = Hospital System Supply Identifier | 876553 = 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: JVCPCT LOCATION | 1054104 = Hospital System Supply Identifier | 876554 = 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: JVCPCT LOCATION | 1054105 = Hospital System Supply Identifier | 876555 = 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: JVCPCT LOCATION | 1054106 = Hospital System Supply Identifier | 876556 = 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: JVCPCT LOCATION | 1054107 = Hospital System Supply Identifier | 876557 = 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: JVCPCT 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: JVCPCT LOCATION | 1054113 = Hospital System Supply Identifier | 876563 = 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: JVCPCT LOCATION | 1054111 = Hospital System Supply Identifier | 876561 = 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: JVCPCT LOCATION | 1054110 = Hospital System Supply Identifier | 876560 = 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: JVCPCT LOCATION | 1054109 = Hospital System Supply Identifier | 876559 = 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: JVCPCT LOCATION | 1054108 = Hospital System Supply Identifier | 876558 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054124 = Hospital System Supply Identifier | 876574 = 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: JVCPCT LOCATION | 1054128 = Hospital System Supply Identifier | 876578 = 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: JVCPCT LOCATION | 1054127 = Hospital System Supply Identifier | 876577 = 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: JVCPCT LOCATION | 1054129 = Hospital System Supply Identifier | 876579 = 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: JVCPCT LOCATION | 1054125 = Hospital System Supply Identifier | 876575 = 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: JVCPCT LOCATION | 1054126 = Hospital System Supply Identifier | 876576 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054135 = Hospital System Supply Identifier | 876585 = 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: JVCPCT LOCATION | 1054137 = Hospital System Supply Identifier | 876587 = 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: JVCPCT LOCATION | 1054138 = Hospital System Supply Identifier | 876588 = 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: JVCPCT LOCATION | 1054139 = Hospital System Supply Identifier | 876589 = 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: JVCPCT LOCATION | 1054140 = Hospital System Supply Identifier | 876590 = 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: JVCPCT LOCATION | 1054141 = Hospital System Supply Identifier | 876591 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054144 = Hospital System Supply Identifier | 876594 = 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: JVCPCT LOCATION | 1054147 = Hospital System Supply Identifier | 876597 = 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: JVCPCT LOCATION | 1054146 = Hospital System Supply Identifier | 876596 = 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: JVCPCT LOCATION | 1054145 = Hospital System Supply Identifier | 876595 = 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: JVCPCT 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: JVCPCT LOCATION | 1054149 = Hospital System Supply Identifier | 876599 = 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: JVCPCT LOCATION | 1054150 = Hospital System Supply Identifier | 876600 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054153 = Hospital System Supply Identifier | 876603 = 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: JVCPCT LOCATION | 1054155 = Hospital System Supply Identifier | 876605 = 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: JVCPCT LOCATION | 1054154 = Hospital System Supply Identifier | 876604 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054165 = Hospital System Supply Identifier | 876615 = 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: JVCPCT LOCATION | 1054166 = Hospital System Supply Identifier | 876616 = 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: JVCPCT LOCATION | 1054167 = Hospital System Supply Identifier | 876617 = 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: JVCPCT LOCATION | 1054168 = Hospital System Supply Identifier | 876618 = 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: JVCPCT LOCATION | 1054169 = Hospital System Supply Identifier | 876619 = 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: JVCPCT LOCATION | 1054170 = Hospital System Supply Identifier | 876620 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054181 = Hospital System Supply Identifier | 876631 = 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: JVCPCT LOCATION | 1054183 = Hospital System Supply Identifier | 876633 = 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: JVCPCT LOCATION | 1054182 = Hospital System Supply Identifier | 876632 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054187 = Hospital System Supply Identifier | 876637 = 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: JVCPCT LOCATION | 1054188 = Hospital System Supply Identifier | 876638 = 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: JVCPCT LOCATION | 1054189 = Hospital System Supply Identifier | 876639 = 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: JVCPCT LOCATION | 1054190 = Hospital System Supply Identifier | 876640 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054198 = Hospital System Supply Identifier | 876648 = 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: JVCPCT LOCATION | 1054202 = Hospital System Supply Identifier | 876652 = 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: JVCPCT LOCATION | 1054201 = Hospital System Supply Identifier | 876651 = 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: JVCPCT 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: JVCPCT LOCATION | 1054200 = Hospital System Supply Identifier | 876650 = 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: JVCPCT LOCATION | 1054203 = Hospital System Supply Identifier | 876653 = 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: JVCPCT LOCATION | 1054204 = Hospital System Supply Identifier | 876654 = 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: JVCPCT LOCATION | 1054205 = Hospital System Supply Identifier | 876655 = 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: JVCPCT LOCATION | 1054206 = Hospital System Supply Identifier | 876656 = 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: JVCPCT LOCATION | 1054207 = Hospital System Supply Identifier | 876657 = 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: JVCPCT LOCATION | 1054210 = Hospital System Supply Identifier | 876660 = 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: JVCPCT LOCATION | 1054212 = Hospital System Supply Identifier | 876662 = 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: JVCPCT LOCATION | 1054211 = Hospital System Supply Identifier | 876661 = 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: JVCPCT LOCATION | 1054209 = Hospital System Supply Identifier | 876659 = 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: JVCPCT LOCATION | 1054208 = Hospital System Supply Identifier | 876658 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054215 = Hospital System Supply Identifier | 876665 = 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: JVCPCT LOCATION | 1054216 = Hospital System Supply Identifier | 876666 = 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: JVCPCT LOCATION | 1054217 = Hospital System Supply Identifier | 876667 = 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: JVCPCT LOCATION | 1054219 = Hospital System Supply Identifier | 876669 = 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: JVCPCT LOCATION | 1054222 = Hospital System Supply Identifier | 876672 = 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: JVCPCT LOCATION | 1054221 = Hospital System Supply Identifier | 876671 = 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: JVCPCT LOCATION | 1054218 = Hospital System Supply Identifier | 876668 = 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: JVCPCT LOCATION | 1054220 = Hospital System Supply Identifier | 876670 = 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: JVCPCT LOCATION | 1054223 = Hospital System Supply Identifier | 876673 = 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: JVCPCT LOCATION | 1054224 = Hospital System Supply Identifier | 876674 = 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: JVCPCT LOCATION | 1054225 = Hospital System Supply Identifier | 876675 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054234 = Hospital System Supply Identifier | 876684 = 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: JVCPCT 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: JVCPCT LOCATION | 1054232 = Hospital System Supply Identifier | 876682 = 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: JVCPCT 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: JVCPCT LOCATION | 1054235 = Hospital System Supply Identifier | 876685 = 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: JVCPCT LOCATION | 1054240 = Hospital System Supply Identifier | 876690 = 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: JVCPCT LOCATION | 1054239 = Hospital System Supply Identifier | 876689 = 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: JVCPCT 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: JVCPCT LOCATION | 1054238 = Hospital System Supply Identifier | 876688 = 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: JVCPCT LOCATION | 1054236 = Hospital System Supply Identifier | 876686 = 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: JVCPCT 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: JVCPCT LOCATION | 1054242 = Hospital System Supply Identifier | 876692 = 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: JVCPCT 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: JVCPCT LOCATION | 1054244 = Hospital System Supply Identifier | 876694 = 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: JVCPCT LOCATION | 1054245 = Hospital System Supply Identifier | 876695 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054252 = Hospital System Supply Identifier | 876702 = 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: JVCPCT LOCATION | 1054257 = Hospital System Supply Identifier | 876707 = 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: JVCPCT LOCATION | 1054255 = Hospital System Supply Identifier | 876705 = 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: JVCPCT LOCATION | 1054256 = Hospital System Supply Identifier | 876706 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054262 = Hospital System Supply Identifier | 876712 = 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: JVCPCT LOCATION | 1054264 = Hospital System Supply Identifier | 876714 = 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: JVCPCT LOCATION | 1054263 = Hospital System Supply Identifier | 876713 = 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: JVCPCT LOCATION | 1054265 = Hospital System Supply Identifier | 876715 = 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: JVCPCT LOCATION | 1054266 = Hospital System Supply Identifier | 876716 = 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: JVCPCT LOCATION | 1054267 = Hospital System Supply Identifier | 876717 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054270 = Hospital System Supply Identifier | 876720 = 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: JVCPCT LOCATION | 1054272 = Hospital System Supply Identifier | 876722 = 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: JVCPCT LOCATION | 1054271 = Hospital System Supply Identifier | 876721 = 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: JVCPCT 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: JVCPCT LOCATION | 1054274 = Hospital System Supply Identifier | 876724 = 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: JVCPCT 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: JVCPCT LOCATION | 1054276 = Hospital System Supply Identifier | 876726 = 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: JVCPCT LOCATION | 1054277 = Hospital System Supply Identifier | 876727 = 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: JVCPCT 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: JVCPCT LOCATION | 1054279 = Hospital System Supply Identifier | 876729 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054284 = Hospital System Supply Identifier | 876734 = 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: JVCPCT 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: JVCPCT LOCATION | 1054286 = Hospital System Supply Identifier | 876736 = 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: JVCPCT 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: JVCPCT LOCATION | 1054288 = Hospital System Supply Identifier | 876738 = 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: JVCPCT LOCATION | 1054289 = Hospital System Supply Identifier | 876739 = 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: JVCPCT 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: JVCPCT LOCATION | 1054292 = Hospital System Supply Identifier | 876742 = 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: JVCPCT LOCATION | 1054290 = Hospital System Supply Identifier | 876740 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054295 = Hospital System Supply Identifier | 876745 = 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: JVCPCT 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: JVCPCT LOCATION | 700597 = Hospital System Supply Identifier | 723733 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1356711 = Hospital System Supply Identifier | 1083690 = 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: JVCPCT LOCATION | 1054296 = Hospital System Supply Identifier | 876746 = 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: JVCPCT LOCATION | 899729 = Hospital System Supply Identifier | 593216 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 899731 = Hospital System Supply Identifier | 593218 = 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: JVCPCT LOCATION | 1054298 = Hospital System Supply Identifier | 876748 = 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: JVCPCT 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: JVCPCT LOCATION | 899732 = Hospital System Supply Identifier | 593219 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054308 = Hospital System Supply Identifier | 876758 = 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: JVCPCT LOCATION | 1054309 = Hospital System Supply Identifier | 876759 = 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: JVCPCT LOCATION | 1054310 = Hospital System Supply Identifier | 876760 = 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: JVCPCT LOCATION | 1054311 = Hospital System Supply Identifier | 876761 = 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: JVCPCT LOCATION | 1054314 = Hospital System Supply Identifier | 876764 = 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: JVCPCT 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: JVCPCT LOCATION | 1054313 = Hospital System Supply Identifier | 876763 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054318 = Hospital System Supply Identifier | 876768 = 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: JVCPCT LOCATION | 1054319 = Hospital System Supply Identifier | 876769 = 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: JVCPCT LOCATION | 1054320 = Hospital System Supply Identifier | 876770 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 700425 = Hospital System Supply Identifier | 723561 = 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: JVCPCT 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: JVCPCT LOCATION | 700557 = Hospital System Supply Identifier | 723693 = 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: JVCPCT LOCATION | 1050848 = Hospital System Supply Identifier | 414029 = 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: JVCPCT LOCATION | 1050847 = Hospital System Supply Identifier | 414028 = 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: JVCPCT LOCATION | 1050849 = Hospital System Supply Identifier | 414030 = 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: JVCPCT 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: JVCPCT LOCATION | 1050846 = Hospital System Supply Identifier | 414027 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1050854 = Hospital System Supply Identifier | 414035 = 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: JVCPCT LOCATION | 1051006 = Hospital System Supply Identifier | 414193 = 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: JVCPCT LOCATION | 833243 = Hospital System Supply Identifier | S392027 = 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: JVCPCT LOCATION | 819438 = Hospital System Supply Identifier | S282456 = 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: JVCPCT LOCATION | 1050857 = Hospital System Supply Identifier | 414038 = 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: JVCPCT LOCATION | 1050855 = Hospital System Supply Identifier | 414036 = 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: JVCPCT LOCATION | 1357259 = Hospital System Supply Identifier | 1083572 = 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: JVCPCT LOCATION | 1050856 = Hospital System Supply Identifier | 414037 = 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: JVCPCT 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: JVCPCT LOCATION | 1050840 = Hospital System Supply Identifier | 410082 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1050858 = Hospital System Supply Identifier | 414040 = 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: JVCPCT LOCATION | 1050859 = Hospital System Supply Identifier | 414041 = 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: JVCPCT LOCATION | 1050860 = Hospital System Supply Identifier | 414042 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1050865 = Hospital System Supply Identifier | 414048 = 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: JVCPCT LOCATION | 1050867 = Hospital System Supply Identifier | 414050 = 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: JVCPCT LOCATION | 1050870 = Hospital System Supply Identifier | 414053 = 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: JVCPCT 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: JVCPCT LOCATION | 1050866 = Hospital System Supply Identifier | 414049 = 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: JVCPCT LOCATION | 1050868 = Hospital System Supply Identifier | 414051 = 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: JVCPCT LOCATION | 1050871 = Hospital System Supply Identifier | 414054 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1050873 = Hospital System Supply Identifier | 414056 = 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: JVCPCT LOCATION | 1050874 = Hospital System Supply Identifier | 414057 = 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: JVCPCT LOCATION | 821159 = Hospital System Supply Identifier | S282457 = 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: JVCPCT 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: JVCPCT LOCATION | 1050718 = Hospital System Supply Identifier | 399822 = 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: JVCPCT 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: JVCPCT LOCATION | 821174 = Hospital System Supply Identifier | S282468 = 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: JVCPCT LOCATION | 833238 = Hospital System Supply Identifier | S392022 = 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: JVCPCT 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: JVCPCT LOCATION | 833237 = Hospital System Supply Identifier | S392021 = 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: JVCPCT LOCATION | 1051020 = Hospital System Supply Identifier | 431449 = 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: JVCPCT LOCATION | 1050720 = Hospital System Supply Identifier | 399828 = 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: JVCPCT 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: JVCPCT LOCATION | 1050875 = Hospital System Supply Identifier | 414058 = 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: JVCPCT LOCATION | 1050876 = Hospital System Supply Identifier | 414059 = 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: JVCPCT LOCATION | 1050877 = Hospital System Supply Identifier | 414060 = 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: JVCPCT LOCATION | 833239 = Hospital System Supply Identifier | S392023 = 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: JVCPCT LOCATION | 1050882 = Hospital System Supply Identifier | 414066 = 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: JVCPCT LOCATION | 1050881 = Hospital System Supply Identifier | 414065 = 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: JVCPCT LOCATION | 1050879 = Hospital System Supply Identifier | 414063 = 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: JVCPCT LOCATION | 1050878 = Hospital System Supply Identifier | 414062 = 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: JVCPCT LOCATION | 1050880 = Hospital System Supply Identifier | 414064 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1050885 = Hospital System Supply Identifier | 414071 = 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: JVCPCT LOCATION | 1050723 = Hospital System Supply Identifier | 399832 = 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: JVCPCT LOCATION | 1050722 = Hospital System Supply Identifier | 399830 = 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: JVCPCT LOCATION | 880906 = Hospital System Supply Identifier | 399831 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 821186 = Hospital System Supply Identifier | S282461 = 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: JVCPCT 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: JVCPCT LOCATION | 1050728 = Hospital System Supply Identifier | 399840 = 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: JVCPCT LOCATION | 1050729 = Hospital System Supply Identifier | 399841 = 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: JVCPCT LOCATION | 1050886 = Hospital System Supply Identifier | 414072 = 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: JVCPCT 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: JVCPCT LOCATION | 1050733 = Hospital System Supply Identifier | 399845 = 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: JVCPCT 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: JVCPCT LOCATION | 1050731 = Hospital System Supply Identifier | 399843 = 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: JVCPCT 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: JVCPCT LOCATION | 833242 = Hospital System Supply Identifier | S392026 = 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: JVCPCT LOCATION | 1050888 = Hospital System Supply Identifier | 414075 = 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: JVCPCT LOCATION | 1050736 = Hospital System Supply Identifier | 399848 = 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: JVCPCT LOCATION | 1050887 = Hospital System Supply Identifier | 414073 = 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: JVCPCT LOCATION | 1050735 = Hospital System Supply Identifier | 399847 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1050891 = Hospital System Supply Identifier | 414078 = 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: JVCPCT LOCATION | 1050896 = Hospital System Supply Identifier | 414083 = 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: JVCPCT 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: JVCPCT LOCATION | 1050895 = Hospital System Supply Identifier | 414082 = 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: JVCPCT 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: JVCPCT LOCATION | 1050893 = Hospital System Supply Identifier | 414080 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1050899 = Hospital System Supply Identifier | 414086 = 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: JVCPCT LOCATION | 1050900 = Hospital System Supply Identifier | 414087 = 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: JVCPCT LOCATION | 1050901 = Hospital System Supply Identifier | 414088 = 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: JVCPCT LOCATION | 1050906 = Hospital System Supply Identifier | 414093 = 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: JVCPCT LOCATION | 1050905 = Hospital System Supply Identifier | 414092 = 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: JVCPCT LOCATION | 1050903 = Hospital System Supply Identifier | 414090 = 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: JVCPCT LOCATION | 1050902 = Hospital System Supply Identifier | 414089 = 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: JVCPCT LOCATION | 1050904 = Hospital System Supply Identifier | 414091 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1050909 = Hospital System Supply Identifier | 414096 = 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: JVCPCT LOCATION | 1050910 = Hospital System Supply Identifier | 414097 = 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: JVCPCT LOCATION | 1050911 = Hospital System Supply Identifier | 414098 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1050922 = Hospital System Supply Identifier | 414109 = 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: JVCPCT LOCATION | 1050920 = Hospital System Supply Identifier | 414107 = 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: JVCPCT LOCATION | 1050921 = Hospital System Supply Identifier | 414108 = 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: JVCPCT LOCATION | 1050918 = Hospital System Supply Identifier | 414105 = 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: JVCPCT LOCATION | 1050919 = Hospital System Supply Identifier | 414106 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1050927 = Hospital System Supply Identifier | 414114 = 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: JVCPCT LOCATION | 1050930 = Hospital System Supply Identifier | 414117 = 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: JVCPCT 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: JVCPCT LOCATION | 1050929 = Hospital System Supply Identifier | 414116 = 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: JVCPCT LOCATION | 1050931 = Hospital System Supply Identifier | 414118 = 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: JVCPCT LOCATION | 1050932 = Hospital System Supply Identifier | 414119 = 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: JVCPCT LOCATION | 1050936 = Hospital System Supply Identifier | 414123 = 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: JVCPCT LOCATION | 1050935 = Hospital System Supply Identifier | 414122 = 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: JVCPCT LOCATION | 1050937 = Hospital System Supply Identifier | 414124 = 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: JVCPCT 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: JVCPCT LOCATION | 1050934 = Hospital System Supply Identifier | 414121 = 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: JVCPCT 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: JVCPCT LOCATION | 1050941 = Hospital System Supply Identifier | 414128 = 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: JVCPCT LOCATION | 1050938 = Hospital System Supply Identifier | 414125 = 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: JVCPCT LOCATION | 1050939 = Hospital System Supply Identifier | 414126 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1050944 = Hospital System Supply Identifier | 414131 = 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: JVCPCT 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: JVCPCT LOCATION | 1050946 = Hospital System Supply Identifier | 414133 = 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: JVCPCT LOCATION | 1050947 = Hospital System Supply Identifier | 414134 = 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: JVCPCT LOCATION | 1050948 = Hospital System Supply Identifier | 414135 = 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: JVCPCT LOCATION | 1050949 = Hospital System Supply Identifier | 414136 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1050952 = Hospital System Supply Identifier | 414139 = 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: JVCPCT LOCATION | 1050955 = Hospital System Supply Identifier | 414142 = 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: JVCPCT LOCATION | 1050954 = Hospital System Supply Identifier | 414141 = 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: JVCPCT LOCATION | 1050953 = Hospital System Supply Identifier | 414140 = 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: JVCPCT LOCATION | 1050844 = Hospital System Supply Identifier | 410086 = 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: JVCPCT LOCATION | 1050843 = Hospital System Supply Identifier | 410085 = 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: JVCPCT LOCATION | 1050956 = Hospital System Supply Identifier | 414143 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1050958 = Hospital System Supply Identifier | 414145 = 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: JVCPCT LOCATION | 1050959 = Hospital System Supply Identifier | 414146 = 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: JVCPCT LOCATION | 1050960 = Hospital System Supply Identifier | 414147 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1050968 = Hospital System Supply Identifier | 414155 = 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: JVCPCT LOCATION | 1050966 = Hospital System Supply Identifier | 414153 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1050738 = Hospital System Supply Identifier | 399850 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1050972 = Hospital System Supply Identifier | 414159 = 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: JVCPCT LOCATION | 1050741 = Hospital System Supply Identifier | 399853 = 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: JVCPCT LOCATION | 1050740 = Hospital System Supply Identifier | 399852 = 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: JVCPCT LOCATION | 1050742 = Hospital System Supply Identifier | 399854 = 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: JVCPCT LOCATION | 1050973 = Hospital System Supply Identifier | 414160 = 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: JVCPCT LOCATION | 1050974 = Hospital System Supply Identifier | 414161 = 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: JVCPCT 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: JVCPCT LOCATION | 1050976 = Hospital System Supply Identifier | 414163 = 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: JVCPCT 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: JVCPCT LOCATION | 1050744 = Hospital System Supply Identifier | 399856 = 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: JVCPCT LOCATION | 1050977 = Hospital System Supply Identifier | 414164 = 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: JVCPCT LOCATION | 1050978 = Hospital System Supply Identifier | 414165 = 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: JVCPCT LOCATION | 1050745 = Hospital System Supply Identifier | 399857 = 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: JVCPCT LOCATION | 1050746 = Hospital System Supply Identifier | 399858 = 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: JVCPCT LOCATION | 1050747 = Hospital System Supply Identifier | 399859 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1050981 = Hospital System Supply Identifier | 414168 = 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: JVCPCT LOCATION | 1050985 = Hospital System Supply Identifier | 414172 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1050984 = Hospital System Supply Identifier | 414171 = 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: JVCPCT LOCATION | 1050986 = Hospital System Supply Identifier | 414173 = 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: JVCPCT LOCATION | 1050748 = Hospital System Supply Identifier | 399860 = 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: JVCPCT LOCATION | 1050749 = Hospital System Supply Identifier | 399861 = 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: JVCPCT LOCATION | 1050987 = Hospital System Supply Identifier | 414174 = 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: JVCPCT LOCATION | 1050988 = Hospital System Supply Identifier | 414175 = 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: JVCPCT LOCATION | 1050989 = Hospital System Supply Identifier | 414176 = 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: JVCPCT LOCATION | 1050751 = Hospital System Supply Identifier | 399863 = 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: JVCPCT LOCATION | 1050990 = Hospital System Supply Identifier | 414177 = 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: JVCPCT LOCATION | 1050753 = Hospital System Supply Identifier | 399865 = 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: JVCPCT LOCATION | 1050750 = Hospital System Supply Identifier | 399862 = 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: JVCPCT LOCATION | 1050752 = Hospital System Supply Identifier | 399864 = 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: JVCPCT LOCATION | 1050754 = Hospital System Supply Identifier | 399866 = 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: JVCPCT LOCATION | 1050755 = Hospital System Supply Identifier | 399867 = 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: JVCPCT LOCATION | 1050756 = Hospital System Supply Identifier | 399868 = 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: JVCPCT LOCATION | 1050757 = Hospital System Supply Identifier | 399869 = 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: JVCPCT LOCATION | 1050991 = Hospital System Supply Identifier | 414178 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1050995 = Hospital System Supply Identifier | 414182 = 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: JVCPCT LOCATION | 1050997 = Hospital System Supply Identifier | 414184 = 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: JVCPCT LOCATION | 1050996 = Hospital System Supply Identifier | 414183 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054387 = Hospital System Supply Identifier | 876837 = 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: JVCPCT LOCATION | 1054389 = Hospital System Supply Identifier | 876839 = 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: JVCPCT LOCATION | 1054390 = Hospital System Supply Identifier | 876840 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054394 = Hospital System Supply Identifier | 876844 = 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: JVCPCT LOCATION | 1054395 = Hospital System Supply Identifier | 876845 = 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: JVCPCT LOCATION | 971153 = Hospital System Supply Identifier | 841865 = 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: JVCPCT 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: JVCPCT LOCATION | 1054397 = Hospital System Supply Identifier | 876847 = 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: JVCPCT LOCATION | 1054398 = Hospital System Supply Identifier | 876848 = 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: JVCPCT LOCATION | 1054399 = Hospital System Supply Identifier | 876849 = 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: JVCPCT LOCATION | 1054402 = Hospital System Supply Identifier | 876852 = 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: JVCPCT 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: JVCPCT LOCATION | 1054401 = Hospital System Supply Identifier | 876851 = 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: JVCPCT LOCATION | 1054406 = Hospital System Supply Identifier | 876856 = 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: JVCPCT LOCATION | 1054405 = Hospital System Supply Identifier | 876855 = 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: JVCPCT 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: JVCPCT LOCATION | 1054404 = Hospital System Supply Identifier | 876854 = 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: JVCPCT LOCATION | 1054407 = Hospital System Supply Identifier | 876857 = 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: JVCPCT 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: JVCPCT LOCATION | 1054409 = Hospital System Supply Identifier | 876859 = 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: JVCPCT LOCATION | 1054413 = Hospital System Supply Identifier | 876863 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054412 = Hospital System Supply Identifier | 876862 = 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: JVCPCT LOCATION | 1054418 = Hospital System Supply Identifier | 876868 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054416 = Hospital System Supply Identifier | 876866 = 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: JVCPCT LOCATION | 1054420 = Hospital System Supply Identifier | 876870 = 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: JVCPCT LOCATION | 1054419 = Hospital System Supply Identifier | 876869 = 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: JVCPCT LOCATION | 1054421 = Hospital System Supply Identifier | 876871 = 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: JVCPCT LOCATION | 1054426 = Hospital System Supply Identifier | 876876 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054424 = Hospital System Supply Identifier | 876874 = 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: JVCPCT LOCATION | 1054427 = Hospital System Supply Identifier | 876877 = 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: JVCPCT LOCATION | 1054428 = Hospital System Supply Identifier | 876878 = 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: JVCPCT LOCATION | 1054429 = Hospital System Supply Identifier | 876879 = 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: JVCPCT LOCATION | 1054430 = Hospital System Supply Identifier | 876880 = 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: JVCPCT LOCATION | 1054431 = Hospital System Supply Identifier | 876881 = 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: JVCPCT LOCATION | 1054432 = Hospital System Supply Identifier | 876882 = 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: JVCPCT LOCATION | 1054433 = Hospital System Supply Identifier | 876883 = 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: JVCPCT LOCATION | 1054434 = Hospital System Supply Identifier | 876884 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054439 = Hospital System Supply Identifier | 876889 = 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: JVCPCT LOCATION | 1054442 = Hospital System Supply Identifier | 876892 = 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: JVCPCT LOCATION | 1054441 = Hospital System Supply Identifier | 876891 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054451 = Hospital System Supply Identifier | 876901 = 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: JVCPCT LOCATION | 1054452 = Hospital System Supply Identifier | 876902 = 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: JVCPCT LOCATION | 1054453 = Hospital System Supply Identifier | 876903 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054457 = Hospital System Supply Identifier | 876907 = 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: JVCPCT LOCATION | 1054459 = Hospital System Supply Identifier | 876909 = 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: JVCPCT LOCATION | 1054458 = Hospital System Supply Identifier | 876908 = 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: JVCPCT LOCATION | 1054460 = Hospital System Supply Identifier | 876910 = 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: JVCPCT LOCATION | 1054461 = Hospital System Supply Identifier | 876911 = 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: JVCPCT LOCATION | 1054462 = Hospital System Supply Identifier | 876912 = 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: JVCPCT LOCATION | 1054463 = Hospital System Supply Identifier | 876913 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054470 = Hospital System Supply Identifier | 876920 = 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: JVCPCT LOCATION | 1054471 = Hospital System Supply Identifier | 876921 = 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: JVCPCT LOCATION | 1054472 = Hospital System Supply Identifier | 876922 = 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: JVCPCT LOCATION | 1054473 = Hospital System Supply Identifier | 876923 = 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: JVCPCT LOCATION | 1054474 = Hospital System Supply Identifier | 876924 = 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: JVCPCT LOCATION | 1054476 = Hospital System Supply Identifier | 876926 = 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: JVCPCT LOCATION | 1054475 = Hospital System Supply Identifier | 876925 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054491 = Hospital System Supply Identifier | 876941 = 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: JVCPCT LOCATION | 1054493 = Hospital System Supply Identifier | 876943 = 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: JVCPCT LOCATION | 1054492 = Hospital System Supply Identifier | 876942 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054511 = Hospital System Supply Identifier | 876961 = 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: JVCPCT LOCATION | 1054516 = Hospital System Supply Identifier | 876966 = 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: JVCPCT LOCATION | 1054515 = Hospital System Supply Identifier | 876965 = 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: JVCPCT 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: JVCPCT LOCATION | 1054513 = Hospital System Supply Identifier | 876963 = 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: JVCPCT LOCATION | 1054514 = Hospital System Supply Identifier | 876964 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054519 = Hospital System Supply Identifier | 876969 = 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: JVCPCT LOCATION | 1054528 = Hospital System Supply Identifier | 876978 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054527 = Hospital System Supply Identifier | 876977 = 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: JVCPCT 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: JVCPCT LOCATION | 1054535 = Hospital System Supply Identifier | 876985 = 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: JVCPCT LOCATION | 1054536 = Hospital System Supply Identifier | 876986 = 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: JVCPCT LOCATION | 1054534 = Hospital System Supply Identifier | 876984 = 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: JVCPCT 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: JVCPCT LOCATION | 1054532 = Hospital System Supply Identifier | 876982 = 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: JVCPCT LOCATION | 1054531 = Hospital System Supply Identifier | 876981 = 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: JVCPCT LOCATION | 1054533 = Hospital System Supply Identifier | 876983 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054539 = Hospital System Supply Identifier | 876989 = 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: JVCPCT LOCATION | 1054540 = Hospital System Supply Identifier | 876990 = 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: JVCPCT LOCATION | 1054541 = Hospital System Supply Identifier | 876991 = 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: JVCPCT LOCATION | 1054543 = Hospital System Supply Identifier | 876993 = 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: JVCPCT LOCATION | 1054542 = Hospital System Supply Identifier | 876992 = 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: JVCPCT LOCATION | 1054544 = Hospital System Supply Identifier | 876994 = 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: JVCPCT LOCATION | 1054545 = Hospital System Supply Identifier | 876995 = 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: JVCPCT LOCATION | 1054546 = Hospital System Supply Identifier | 876996 = 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: JVCPCT 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: JVCPCT LOCATION | 1054548 = Hospital System Supply Identifier | 876998 = 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: JVCPCT LOCATION | 1054549 = Hospital System Supply Identifier | 876999 = 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: JVCPCT LOCATION | 1054554 = Hospital System Supply Identifier | 877004 = 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: JVCPCT LOCATION | 1054553 = Hospital System Supply Identifier | 877003 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054552 = Hospital System Supply Identifier | 877002 = 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: JVCPCT 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: JVCPCT LOCATION | 1054556 = Hospital System Supply Identifier | 877006 = 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: JVCPCT LOCATION | 1054557 = Hospital System Supply Identifier | 877007 = 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: JVCPCT LOCATION | 1054558 = Hospital System Supply Identifier | 877008 = 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: JVCPCT LOCATION | 1054559 = Hospital System Supply Identifier | 877009 = 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: JVCPCT LOCATION | 1054560 = Hospital System Supply Identifier | 877010 = 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: JVCPCT LOCATION | 1054565 = Hospital System Supply Identifier | 877015 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054564 = Hospital System Supply Identifier | 877014 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054574 = Hospital System Supply Identifier | 877024 = 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: JVCPCT LOCATION | 1054579 = Hospital System Supply Identifier | 877029 = 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: JVCPCT LOCATION | 1054578 = Hospital System Supply Identifier | 877028 = 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: JVCPCT LOCATION | 1054576 = Hospital System Supply Identifier | 877026 = 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: JVCPCT LOCATION | 1054575 = Hospital System Supply Identifier | 877025 = 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: JVCPCT LOCATION | 1054577 = Hospital System Supply Identifier | 877027 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054582 = Hospital System Supply Identifier | 877032 = 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: JVCPCT 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: JVCPCT LOCATION | 1054587 = Hospital System Supply Identifier | 877037 = 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: JVCPCT LOCATION | 1054585 = Hospital System Supply Identifier | 877035 = 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: JVCPCT 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: JVCPCT LOCATION | 1054584 = Hospital System Supply Identifier | 877034 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054590 = Hospital System Supply Identifier | 877040 = 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: JVCPCT LOCATION | 1054591 = Hospital System Supply Identifier | 877041 = 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: JVCPCT LOCATION | 1054592 = Hospital System Supply Identifier | 877042 = 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: JVCPCT LOCATION | 1054597 = Hospital System Supply Identifier | 877047 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054596 = Hospital System Supply Identifier | 877046 = 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: JVCPCT LOCATION | 1054600 = Hospital System Supply Identifier | 877050 = 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: JVCPCT LOCATION | 1054601 = Hospital System Supply Identifier | 877051 = 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: JVCPCT 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: JVCPCT LOCATION | 1054599 = Hospital System Supply Identifier | 877049 = 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: JVCPCT LOCATION | 1054602 = Hospital System Supply Identifier | 877052 = 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: JVCPCT LOCATION | 1054604 = Hospital System Supply Identifier | 877054 = 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: JVCPCT LOCATION | 1054603 = Hospital System Supply Identifier | 877053 = 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: JVCPCT LOCATION | 1054605 = Hospital System Supply Identifier | 877055 = 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: JVCPCT LOCATION | 20122 = Hospital System Supply Identifier | 238388 = 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: JVCPCT LOCATION | 176737 = Hospital System Supply Identifier | 308783 = 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: JVCPCT LOCATION | 407535 = Hospital System Supply Identifier | 202373 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 411228 = Hospital System Supply Identifier | 461757 = 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: JVCPCT LOCATION | 721296 = Hospital System Supply Identifier | 732743 = 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: JVCPCT LOCATION | 408777 = Hospital System Supply Identifier | 339879 = 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: JVCPCT LOCATION | 408775 = Hospital System Supply Identifier | 339877 = 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: JVCPCT LOCATION | 408776 = Hospital System Supply Identifier | 339878 = 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: JVCPCT LOCATION | 408773 = Hospital System Supply Identifier | 339875 = 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: JVCPCT LOCATION | 408774 = Hospital System Supply Identifier | 339876 = 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: JVCPCT 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: JVCPCT LOCATION | 16374 = Hospital System Supply Identifier | 131618 = 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: JVCPCT LOCATION | 744077 = Hospital System Supply Identifier | 421234 = 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: JVCPCT LOCATION | 1054606 = Hospital System Supply Identifier | 877056 = 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: JVCPCT 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: JVCPCT LOCATION | 1054608 = Hospital System Supply Identifier | 877058 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 813192 = Hospital System Supply Identifier | S298353 = 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: JVCPCT LOCATION | 1054620 = Hospital System Supply Identifier | 877070 = 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: JVCPCT 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: JVCPCT LOCATION | 1054621 = Hospital System Supply Identifier | 877071 = 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: JVCPCT LOCATION | 1054618 = Hospital System Supply Identifier | 877068 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054614 = Hospital System Supply Identifier | 877064 = 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: JVCPCT LOCATION | 1054617 = Hospital System Supply Identifier | 877067 = 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: JVCPCT LOCATION | 1356811 = Hospital System Supply Identifier | 1082556 = 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: JVCPCT LOCATION | 918407 = Hospital System Supply Identifier | 711670 = 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: JVCPCT LOCATION | 1054622 = Hospital System Supply Identifier | 877072 = 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: JVCPCT LOCATION | 1054623 = Hospital System Supply Identifier | 877073 = 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: JVCPCT LOCATION | 1054624 = Hospital System Supply Identifier | 877074 = 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: JVCPCT LOCATION | 1054625 = Hospital System Supply Identifier | 877075 = 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: JVCPCT LOCATION | 1054626 = Hospital System Supply Identifier | 877076 = 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: JVCPCT LOCATION | 1054627 = Hospital System Supply Identifier | 877077 = 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: JVCPCT LOCATION | 1054628 = Hospital System Supply Identifier | 877078 = 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: JVCPCT LOCATION | 1054629 = Hospital System Supply Identifier | 877079 = 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: JVCPCT LOCATION | 1054630 = Hospital System Supply Identifier | 877080 = 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: JVCPCT LOCATION | 1054632 = Hospital System Supply Identifier | 877082 = 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: JVCPCT LOCATION | 1054631 = Hospital System Supply Identifier | 877081 = 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: JVCPCT LOCATION | 1054633 = Hospital System Supply Identifier | 877083 = 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: JVCPCT LOCATION | 1054634 = Hospital System Supply Identifier | 877084 = 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: JVCPCT LOCATION | 1054635 = Hospital System Supply Identifier | 877085 = 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: JVCPCT 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: JVCPCT LOCATION | 1054637 = Hospital System Supply Identifier | 877087 = 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: JVCPCT LOCATION | 801298 = Hospital System Supply Identifier | S299349 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054644 = Hospital System Supply Identifier | 877094 = 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: JVCPCT LOCATION | 1054648 = Hospital System Supply Identifier | 877098 = 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: JVCPCT LOCATION | 1054647 = Hospital System Supply Identifier | 877097 = 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: JVCPCT LOCATION | 1054649 = Hospital System Supply Identifier | 877099 = 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: JVCPCT 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: JVCPCT LOCATION | 1054646 = Hospital System Supply Identifier | 877096 = 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: JVCPCT LOCATION | 1054650 = Hospital System Supply Identifier | 877100 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054654 = Hospital System Supply Identifier | 877104 = 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: JVCPCT LOCATION | 1054655 = Hospital System Supply Identifier | 877105 = 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: JVCPCT LOCATION | 1054656 = Hospital System Supply Identifier | 877106 = 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: JVCPCT LOCATION | 1054657 = Hospital System Supply Identifier | 877107 = 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: JVCPCT 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: JVCPCT LOCATION | 1054659 = Hospital System Supply Identifier | 877109 = 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: JVCPCT LOCATION | 1356813 = Hospital System Supply Identifier | 1082574 = 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: JVCPCT LOCATION | 1356812 = Hospital System Supply Identifier | 1082571 = 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: JVCPCT LOCATION | 1356584 = Hospital System Supply Identifier | 1082547 = 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: JVCPCT 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: JVCPCT LOCATION | 1356947 = Hospital System Supply Identifier | 1082483 = 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: JVCPCT LOCATION | 1356879 = Hospital System Supply Identifier | 1082448 = 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: JVCPCT LOCATION | 1357050 = Hospital System Supply Identifier | 1082534 = 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: JVCPCT LOCATION | 1054665 = Hospital System Supply Identifier | 877115 = 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: JVCPCT 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: JVCPCT LOCATION | 1054666 = Hospital System Supply Identifier | 877116 = 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: JVCPCT LOCATION | 1054664 = Hospital System Supply Identifier | 877114 = 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: JVCPCT 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: JVCPCT LOCATION | 1054661 = Hospital System Supply Identifier | 877111 = 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: JVCPCT LOCATION | 1054660 = Hospital System Supply Identifier | 877110 = 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: JVCPCT LOCATION | 1054663 = Hospital System Supply Identifier | 877113 = 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: JVCPCT LOCATION | 1054668 = Hospital System Supply Identifier | 877118 = 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: JVCPCT LOCATION | 1054669 = Hospital System Supply Identifier | 877119 = 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: JVCPCT LOCATION | 1054670 = Hospital System Supply Identifier | 877120 = 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: JVCPCT LOCATION | 1054671 = Hospital System Supply Identifier | 877121 = 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: JVCPCT 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: JVCPCT LOCATION | 1054673 = Hospital System Supply Identifier | 877123 = 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: JVCPCT LOCATION | 1054674 = Hospital System Supply Identifier | 877124 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054679 = Hospital System Supply Identifier | 877129 = 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: JVCPCT 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: JVCPCT LOCATION | 1054681 = Hospital System Supply Identifier | 877131 = 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: JVCPCT LOCATION | 1054682 = Hospital System Supply Identifier | 877132 = 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: JVCPCT LOCATION | 1054683 = Hospital System Supply Identifier | 877133 = 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: JVCPCT LOCATION | 1054684 = Hospital System Supply Identifier | 877134 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054701 = Hospital System Supply Identifier | 877151 = 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: JVCPCT LOCATION | 1054703 = Hospital System Supply Identifier | 877153 = 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: JVCPCT LOCATION | 1054702 = Hospital System Supply Identifier | 877152 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054706 = Hospital System Supply Identifier | 877156 = 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: JVCPCT LOCATION | 1054707 = Hospital System Supply Identifier | 877157 = 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: JVCPCT LOCATION | 1054708 = Hospital System Supply Identifier | 877158 = 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: JVCPCT 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: JVCPCT LOCATION | 1054710 = Hospital System Supply Identifier | 877160 = 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: JVCPCT LOCATION | 1054715 = Hospital System Supply Identifier | 877165 = 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: JVCPCT LOCATION | 1054714 = Hospital System Supply Identifier | 877164 = 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: JVCPCT LOCATION | 1054713 = Hospital System Supply Identifier | 877163 = 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: JVCPCT LOCATION | 1054712 = Hospital System Supply Identifier | 877162 = 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: JVCPCT LOCATION | 1054711 = Hospital System Supply Identifier | 877161 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054718 = Hospital System Supply Identifier | 877168 = 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: JVCPCT LOCATION | 1054719 = Hospital System Supply Identifier | 877169 = 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: JVCPCT LOCATION | 1054720 = Hospital System Supply Identifier | 877170 = 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: JVCPCT LOCATION | 1054725 = Hospital System Supply Identifier | 877175 = 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: JVCPCT LOCATION | 1054724 = Hospital System Supply Identifier | 877174 = 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: JVCPCT LOCATION | 1054723 = Hospital System Supply Identifier | 877173 = 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: JVCPCT LOCATION | 1054722 = Hospital System Supply Identifier | 877172 = 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: JVCPCT LOCATION | 1054721 = Hospital System Supply Identifier | 877171 = 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: JVCPCT LOCATION | 1054726 = Hospital System Supply Identifier | 877176 = 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: JVCPCT LOCATION | 1054727 = Hospital System Supply Identifier | 877177 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054730 = Hospital System Supply Identifier | 877180 = 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: JVCPCT LOCATION | 1054735 = Hospital System Supply Identifier | 877185 = 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: JVCPCT LOCATION | 1054734 = Hospital System Supply Identifier | 877184 = 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: JVCPCT LOCATION | 1054732 = Hospital System Supply Identifier | 877182 = 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: JVCPCT LOCATION | 1054731 = Hospital System Supply Identifier | 877181 = 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: JVCPCT LOCATION | 1054733 = Hospital System Supply Identifier | 877183 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054738 = Hospital System Supply Identifier | 877188 = 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: JVCPCT LOCATION | 1054739 = Hospital System Supply Identifier | 877189 = 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: JVCPCT LOCATION | 1054740 = Hospital System Supply Identifier | 877190 = 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: JVCPCT LOCATION | 1054742 = Hospital System Supply Identifier | 877192 = 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: JVCPCT LOCATION | 1054741 = Hospital System Supply Identifier | 877191 = 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: JVCPCT LOCATION | 1054743 = Hospital System Supply Identifier | 877193 = 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: JVCPCT 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: JVCPCT LOCATION | 1054745 = Hospital System Supply Identifier | 877195 = 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: JVCPCT LOCATION | 1054746 = Hospital System Supply Identifier | 877196 = 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: JVCPCT LOCATION | 1054747 = Hospital System Supply Identifier | 877197 = 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: JVCPCT LOCATION | 1054748 = Hospital System Supply Identifier | 877198 = 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: JVCPCT LOCATION | 1054753 = Hospital System Supply Identifier | 877203 = 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: JVCPCT LOCATION | 1054752 = Hospital System Supply Identifier | 877202 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054751 = Hospital System Supply Identifier | 877201 = 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: JVCPCT 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: JVCPCT LOCATION | 1054755 = Hospital System Supply Identifier | 877205 = 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: JVCPCT LOCATION | 1054756 = Hospital System Supply Identifier | 877206 = 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: JVCPCT LOCATION | 1054757 = Hospital System Supply Identifier | 877207 = 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: JVCPCT LOCATION | 1054758 = Hospital System Supply Identifier | 877208 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054771 = Hospital System Supply Identifier | 877221 = 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: JVCPCT 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: JVCPCT LOCATION | 1054767 = Hospital System Supply Identifier | 877217 = 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: JVCPCT LOCATION | 1054769 = Hospital System Supply Identifier | 877219 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054776 = Hospital System Supply Identifier | 877226 = 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: JVCPCT LOCATION | 1054777 = Hospital System Supply Identifier | 877227 = 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: JVCPCT LOCATION | 1054778 = Hospital System Supply Identifier | 877228 = 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: JVCPCT LOCATION | 1054779 = Hospital System Supply Identifier | 877229 = 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: JVCPCT LOCATION | 1054780 = Hospital System Supply Identifier | 877230 = 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: JVCPCT LOCATION | 1054781 = Hospital System Supply Identifier | 877231 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054784 = Hospital System Supply Identifier | 877234 = 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: JVCPCT LOCATION | 1054786 = Hospital System Supply Identifier | 877236 = 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: JVCPCT LOCATION | 1054785 = Hospital System Supply Identifier | 877235 = 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: JVCPCT 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: JVCPCT LOCATION | 1054788 = Hospital System Supply Identifier | 877238 = 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: JVCPCT 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: JVCPCT LOCATION | 1054790 = Hospital System Supply Identifier | 877240 = 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: JVCPCT LOCATION | 1054791 = Hospital System Supply Identifier | 877241 = 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: JVCPCT LOCATION | 1054796 = Hospital System Supply Identifier | 877246 = 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: JVCPCT 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: JVCPCT LOCATION | 1054795 = Hospital System Supply Identifier | 877245 = 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: JVCPCT 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: JVCPCT LOCATION | 1054793 = Hospital System Supply Identifier | 877243 = 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: JVCPCT 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: JVCPCT LOCATION | 1054798 = Hospital System Supply Identifier | 877248 = 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: JVCPCT LOCATION | 1054799 = Hospital System Supply Identifier | 877249 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054804 = Hospital System Supply Identifier | 877254 = 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: JVCPCT 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: JVCPCT LOCATION | 1054806 = Hospital System Supply Identifier | 877256 = 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: JVCPCT 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: JVCPCT LOCATION | 1054808 = Hospital System Supply Identifier | 877258 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054813 = Hospital System Supply Identifier | 877263 = 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: JVCPCT LOCATION | 1054810 = Hospital System Supply Identifier | 877260 = 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: JVCPCT LOCATION | 1054811 = Hospital System Supply Identifier | 877261 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054823 = Hospital System Supply Identifier | 877273 = 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: JVCPCT LOCATION | 1054821 = Hospital System Supply Identifier | 877271 = 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: JVCPCT LOCATION | 1054820 = Hospital System Supply Identifier | 877270 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054827 = Hospital System Supply Identifier | 877277 = 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: JVCPCT LOCATION | 1054832 = Hospital System Supply Identifier | 877282 = 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: JVCPCT 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: JVCPCT LOCATION | 1054831 = Hospital System Supply Identifier | 877281 = 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: JVCPCT 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: JVCPCT LOCATION | 1054829 = Hospital System Supply Identifier | 877279 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054835 = Hospital System Supply Identifier | 877285 = 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: JVCPCT LOCATION | 1054836 = Hospital System Supply Identifier | 877286 = 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: JVCPCT LOCATION | 1054837 = Hospital System Supply Identifier | 877287 = 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: JVCPCT LOCATION | 1054842 = Hospital System Supply Identifier | 877292 = 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: JVCPCT LOCATION | 1054841 = Hospital System Supply Identifier | 877291 = 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: JVCPCT LOCATION | 1054840 = Hospital System Supply Identifier | 877290 = 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: JVCPCT LOCATION | 1054839 = Hospital System Supply Identifier | 877289 = 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: JVCPCT LOCATION | 1054838 = Hospital System Supply Identifier | 877288 = 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: JVCPCT 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: JVCPCT LOCATION | 1054844 = Hospital System Supply Identifier | 877294 = 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: JVCPCT LOCATION | 1054845 = Hospital System Supply Identifier | 877295 = 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: JVCPCT LOCATION | 1054846 = Hospital System Supply Identifier | 877296 = 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: JVCPCT LOCATION | 1054847 = Hospital System Supply Identifier | 877297 = 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: JVCPCT LOCATION | 1054852 = Hospital System Supply Identifier | 877302 = 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: JVCPCT LOCATION | 1054851 = Hospital System Supply Identifier | 877301 = 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: JVCPCT LOCATION | 1054849 = Hospital System Supply Identifier | 877299 = 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: JVCPCT LOCATION | 1054848 = Hospital System Supply Identifier | 877298 = 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: JVCPCT LOCATION | 1054850 = Hospital System Supply Identifier | 877300 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054857 = Hospital System Supply Identifier | 877307 = 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: JVCPCT LOCATION | 1054862 = Hospital System Supply Identifier | 877312 = 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: JVCPCT LOCATION | 1054861 = Hospital System Supply Identifier | 877311 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054860 = Hospital System Supply Identifier | 877310 = 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: JVCPCT LOCATION | 1054863 = Hospital System Supply Identifier | 877313 = 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: JVCPCT LOCATION | 1054864 = Hospital System Supply Identifier | 877314 = 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: JVCPCT LOCATION | 1054865 = Hospital System Supply Identifier | 877315 = 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: JVCPCT LOCATION | 1054866 = Hospital System Supply Identifier | 877316 = 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: JVCPCT LOCATION | 1054867 = Hospital System Supply Identifier | 877317 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054880 = Hospital System Supply Identifier | 877330 = 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: JVCPCT LOCATION | 1054883 = Hospital System Supply Identifier | 877333 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054882 = Hospital System Supply Identifier | 877332 = 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: JVCPCT LOCATION | 1054884 = Hospital System Supply Identifier | 877334 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054887 = Hospital System Supply Identifier | 877337 = 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: JVCPCT LOCATION | 1054888 = Hospital System Supply Identifier | 877338 = 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: JVCPCT LOCATION | 1054889 = Hospital System Supply Identifier | 877339 = 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: JVCPCT LOCATION | 1054893 = Hospital System Supply Identifier | 877343 = 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: JVCPCT 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: JVCPCT LOCATION | 1054894 = Hospital System Supply Identifier | 877344 = 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: JVCPCT 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: JVCPCT LOCATION | 1054891 = Hospital System Supply Identifier | 877341 = 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: JVCPCT LOCATION | 1054895 = Hospital System Supply Identifier | 877345 = 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: JVCPCT 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: JVCPCT LOCATION | 1054897 = Hospital System Supply Identifier | 877347 = 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: JVCPCT LOCATION | 1054898 = Hospital System Supply Identifier | 877348 = 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: JVCPCT LOCATION | 1054899 = Hospital System Supply Identifier | 877349 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054907 = Hospital System Supply Identifier | 877357 = 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: JVCPCT 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: JVCPCT LOCATION | 1054910 = Hospital System Supply Identifier | 877360 = 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: JVCPCT LOCATION | 1054908 = Hospital System Supply Identifier | 877358 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054915 = Hospital System Supply Identifier | 877365 = 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: JVCPCT LOCATION | 1054919 = Hospital System Supply Identifier | 877369 = 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: JVCPCT LOCATION | 1054916 = Hospital System Supply Identifier | 877366 = 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: JVCPCT LOCATION | 1054917 = Hospital System Supply Identifier | 877367 = 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: JVCPCT LOCATION | 1054918 = Hospital System Supply Identifier | 877368 = 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: JVCPCT LOCATION | 1054920 = Hospital System Supply Identifier | 877370 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054925 = Hospital System Supply Identifier | 877375 = 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: JVCPCT 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: JVCPCT LOCATION | 1054930 = Hospital System Supply Identifier | 877380 = 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: JVCPCT LOCATION | 1054928 = Hospital System Supply Identifier | 877378 = 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: JVCPCT 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: JVCPCT LOCATION | 1054926 = Hospital System Supply Identifier | 877376 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054935 = Hospital System Supply Identifier | 877385 = 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: JVCPCT LOCATION | 1054936 = Hospital System Supply Identifier | 877386 = 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: JVCPCT LOCATION | 1054937 = Hospital System Supply Identifier | 877387 = 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: JVCPCT LOCATION | 1054938 = Hospital System Supply Identifier | 877388 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054941 = Hospital System Supply Identifier | 877391 = 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: JVCPCT LOCATION | 1054942 = Hospital System Supply Identifier | 877392 = 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: JVCPCT LOCATION | 1054943 = Hospital System Supply Identifier | 877393 = 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: JVCPCT LOCATION | 1054948 = Hospital System Supply Identifier | 877398 = 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: JVCPCT LOCATION | 1054947 = Hospital System Supply Identifier | 877397 = 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: JVCPCT LOCATION | 1054946 = Hospital System Supply Identifier | 877396 = 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: JVCPCT LOCATION | 1054945 = Hospital System Supply Identifier | 877395 = 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: JVCPCT LOCATION | 1054944 = Hospital System Supply Identifier | 877394 = 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: JVCPCT LOCATION | 1054949 = Hospital System Supply Identifier | 877399 = 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: JVCPCT LOCATION | 1054950 = Hospital System Supply Identifier | 877400 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054953 = Hospital System Supply Identifier | 877403 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054958 = Hospital System Supply Identifier | 877408 = 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: JVCPCT LOCATION | 1054959 = Hospital System Supply Identifier | 877409 = 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: JVCPCT LOCATION | 1054960 = Hospital System Supply Identifier | 877410 = 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: JVCPCT LOCATION | 1054964 = Hospital System Supply Identifier | 877414 = 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: JVCPCT LOCATION | 1054963 = Hospital System Supply Identifier | 877413 = 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: JVCPCT LOCATION | 1054965 = Hospital System Supply Identifier | 877415 = 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: JVCPCT 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: JVCPCT LOCATION | 1054962 = Hospital System Supply Identifier | 877412 = 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: JVCPCT 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: JVCPCT LOCATION | 1054967 = Hospital System Supply Identifier | 877417 = 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: JVCPCT 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: JVCPCT LOCATION | 1054969 = Hospital System Supply Identifier | 877419 = 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: JVCPCT LOCATION | 1054970 = Hospital System Supply Identifier | 877420 = 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: JVCPCT LOCATION | 1054975 = Hospital System Supply Identifier | 877425 = 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: JVCPCT LOCATION | 1054974 = Hospital System Supply Identifier | 877424 = 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: JVCPCT LOCATION | 1054972 = Hospital System Supply Identifier | 877422 = 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: JVCPCT LOCATION | 1054971 = Hospital System Supply Identifier | 877421 = 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: JVCPCT LOCATION | 1054973 = Hospital System Supply Identifier | 877423 = 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: JVCPCT LOCATION | 1054979 = Hospital System Supply Identifier | 877429 = 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: JVCPCT 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: JVCPCT LOCATION | 1054977 = Hospital System Supply Identifier | 877427 = 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: JVCPCT 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: JVCPCT LOCATION | 1054980 = Hospital System Supply Identifier | 877430 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1054990 = Hospital System Supply Identifier | 877440 = 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: JVCPCT LOCATION | 1054991 = Hospital System Supply Identifier | 877441 = 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: JVCPCT LOCATION | 1054992 = Hospital System Supply Identifier | 877442 = 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: JVCPCT LOCATION | 1054993 = Hospital System Supply Identifier | 877443 = 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: JVCPCT LOCATION | 1054994 = Hospital System Supply Identifier | 877444 = 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: JVCPCT LOCATION | 1054995 = Hospital System Supply Identifier | 877445 = 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: JVCPCT LOCATION | 1054999 = Hospital System Supply Identifier | 877449 = 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: JVCPCT LOCATION | 1054998 = Hospital System Supply Identifier | 877448 = 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: JVCPCT LOCATION | 1055000 = Hospital System Supply Identifier | 877450 = 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: JVCPCT 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: JVCPCT LOCATION | 1054997 = Hospital System Supply Identifier | 877447 = 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: JVCPCT LOCATION | 1055002 = Hospital System Supply Identifier | 877452 = 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: JVCPCT LOCATION | 1055001 = Hospital System Supply Identifier | 877451 = 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: JVCPCT LOCATION | 1055003 = Hospital System Supply Identifier | 877453 = 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: JVCPCT LOCATION | 1055004 = Hospital System Supply Identifier | 877454 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055011 = Hospital System Supply Identifier | 877461 = 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: JVCPCT LOCATION | 1055012 = Hospital System Supply Identifier | 877462 = 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: JVCPCT 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: JVCPCT LOCATION | 1055014 = Hospital System Supply Identifier | 877464 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055018 = Hospital System Supply Identifier | 877468 = 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: JVCPCT LOCATION | 1055020 = Hospital System Supply Identifier | 877470 = 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: JVCPCT LOCATION | 1055019 = Hospital System Supply Identifier | 877469 = 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: JVCPCT LOCATION | 1055021 = Hospital System Supply Identifier | 877471 = 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: JVCPCT LOCATION | 1055022 = Hospital System Supply Identifier | 877472 = 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: JVCPCT LOCATION | 1055023 = Hospital System Supply Identifier | 877473 = 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: JVCPCT LOCATION | 1055024 = Hospital System Supply Identifier | 877474 = 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: JVCPCT LOCATION | 1055025 = Hospital System Supply Identifier | 877475 = 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: JVCPCT LOCATION | 1055028 = Hospital System Supply Identifier | 877478 = 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: JVCPCT 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: JVCPCT LOCATION | 1055027 = Hospital System Supply Identifier | 877477 = 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: JVCPCT 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: JVCPCT LOCATION | 1055030 = Hospital System Supply Identifier | 877480 = 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: JVCPCT LOCATION | 1055031 = Hospital System Supply Identifier | 877481 = 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: JVCPCT LOCATION | 1055032 = Hospital System Supply Identifier | 877482 = 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: JVCPCT LOCATION | 1055033 = Hospital System Supply Identifier | 877483 = 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: JVCPCT LOCATION | 1055034 = Hospital System Supply Identifier | 877484 = 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: JVCPCT LOCATION | 1055035 = Hospital System Supply Identifier | 877485 = 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: JVCPCT LOCATION | 1055040 = Hospital System Supply Identifier | 877490 = 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: JVCPCT LOCATION | 1055039 = Hospital System Supply Identifier | 877489 = 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: JVCPCT 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: JVCPCT LOCATION | 1055038 = Hospital System Supply Identifier | 877488 = 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: JVCPCT LOCATION | 1055036 = Hospital System Supply Identifier | 877486 = 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: JVCPCT 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: JVCPCT LOCATION | 1055042 = Hospital System Supply Identifier | 877492 = 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: JVCPCT LOCATION | 1055043 = Hospital System Supply Identifier | 877493 = 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: JVCPCT LOCATION | 1055044 = Hospital System Supply Identifier | 877494 = 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: JVCPCT 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: JVCPCT LOCATION | 1055046 = Hospital System Supply Identifier | 877496 = 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: JVCPCT LOCATION | 1055048 = Hospital System Supply Identifier | 877498 = 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: JVCPCT LOCATION | 1055047 = Hospital System Supply Identifier | 877497 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055052 = Hospital System Supply Identifier | 877502 = 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: JVCPCT LOCATION | 1055053 = Hospital System Supply Identifier | 877503 = 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: JVCPCT LOCATION | 1055054 = Hospital System Supply Identifier | 877504 = 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: JVCPCT LOCATION | 1055056 = Hospital System Supply Identifier | 877506 = 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: JVCPCT LOCATION | 1055055 = Hospital System Supply Identifier | 877505 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055064 = Hospital System Supply Identifier | 877514 = 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: JVCPCT LOCATION | 1055065 = Hospital System Supply Identifier | 877515 = 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: JVCPCT LOCATION | 1055066 = Hospital System Supply Identifier | 877516 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055073 = Hospital System Supply Identifier | 877523 = 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: JVCPCT LOCATION | 1055074 = Hospital System Supply Identifier | 877524 = 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: JVCPCT LOCATION | 1055075 = Hospital System Supply Identifier | 877525 = 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: JVCPCT LOCATION | 1055076 = Hospital System Supply Identifier | 877526 = 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: JVCPCT LOCATION | 1055077 = Hospital System Supply Identifier | 877527 = 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: JVCPCT LOCATION | 1055078 = Hospital System Supply Identifier | 877528 = 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: JVCPCT LOCATION | 1055083 = Hospital System Supply Identifier | 877533 = 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: JVCPCT 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: JVCPCT LOCATION | 1055082 = Hospital System Supply Identifier | 877532 = 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: JVCPCT 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: JVCPCT LOCATION | 1055080 = Hospital System Supply Identifier | 877530 = 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: JVCPCT 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: JVCPCT LOCATION | 1055085 = Hospital System Supply Identifier | 877535 = 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: JVCPCT 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: JVCPCT LOCATION | 1055087 = Hospital System Supply Identifier | 877537 = 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: JVCPCT LOCATION | 1055088 = Hospital System Supply Identifier | 877538 = 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: JVCPCT LOCATION | 1055095 = Hospital System Supply Identifier | 877543 = 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: JVCPCT LOCATION | 1055094 = Hospital System Supply Identifier | 877542 = 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: JVCPCT LOCATION | 1055090 = Hospital System Supply Identifier | 877540 = 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: JVCPCT LOCATION | 1055089 = Hospital System Supply Identifier | 877539 = 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: JVCPCT LOCATION | 1055093 = Hospital System Supply Identifier | 877541 = 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: JVCPCT LOCATION | 1055096 = Hospital System Supply Identifier | 877544 = 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: JVCPCT LOCATION | 1055097 = Hospital System Supply Identifier | 877545 = 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: JVCPCT LOCATION | 1055098 = Hospital System Supply Identifier | 877546 = 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: JVCPCT 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: JVCPCT LOCATION | 1055100 = Hospital System Supply Identifier | 877548 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055107 = Hospital System Supply Identifier | 877555 = 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: JVCPCT LOCATION | 1055108 = Hospital System Supply Identifier | 877556 = 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: JVCPCT LOCATION | 1055109 = Hospital System Supply Identifier | 877557 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055118 = Hospital System Supply Identifier | 877566 = 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: JVCPCT LOCATION | 1055120 = Hospital System Supply Identifier | 877568 = 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: JVCPCT LOCATION | 1055119 = Hospital System Supply Identifier | 877567 = 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: JVCPCT LOCATION | 1055121 = Hospital System Supply Identifier | 877569 = 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: JVCPCT LOCATION | 1055122 = Hospital System Supply Identifier | 877570 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055128 = Hospital System Supply Identifier | 877576 = 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: JVCPCT LOCATION | 1055130 = Hospital System Supply Identifier | 877578 = 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: JVCPCT LOCATION | 1055129 = Hospital System Supply Identifier | 877577 = 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: JVCPCT LOCATION | 1055131 = Hospital System Supply Identifier | 877579 = 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: JVCPCT LOCATION | 1055132 = Hospital System Supply Identifier | 877580 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055140 = Hospital System Supply Identifier | 877588 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055143 = Hospital System Supply Identifier | 877591 = 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: JVCPCT LOCATION | 1055144 = Hospital System Supply Identifier | 877592 = 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: JVCPCT LOCATION | 1055145 = Hospital System Supply Identifier | 877593 = 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: JVCPCT LOCATION | 1055150 = Hospital System Supply Identifier | 877598 = 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: JVCPCT LOCATION | 1055149 = Hospital System Supply Identifier | 877597 = 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: JVCPCT 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: JVCPCT LOCATION | 1055148 = Hospital System Supply Identifier | 877596 = 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: JVCPCT LOCATION | 1055146 = Hospital System Supply Identifier | 877594 = 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: JVCPCT LOCATION | 1055151 = Hospital System Supply Identifier | 877599 = 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: JVCPCT 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: JVCPCT LOCATION | 1055153 = Hospital System Supply Identifier | 877601 = 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: JVCPCT LOCATION | 1055154 = Hospital System Supply Identifier | 877602 = 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: JVCPCT LOCATION | 1055155 = Hospital System Supply Identifier | 877603 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055160 = Hospital System Supply Identifier | 877608 = 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: JVCPCT LOCATION | 1055164 = Hospital System Supply Identifier | 877612 = 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: JVCPCT LOCATION | 1055163 = Hospital System Supply Identifier | 877611 = 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: JVCPCT LOCATION | 1055165 = Hospital System Supply Identifier | 877613 = 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: JVCPCT LOCATION | 1055161 = Hospital System Supply Identifier | 877609 = 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: JVCPCT LOCATION | 1055162 = Hospital System Supply Identifier | 877610 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1356855 = Hospital System Supply Identifier | 1083704 = 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: JVCPCT LOCATION | 1356840 = Hospital System Supply Identifier | 1082597 = 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: JVCPCT LOCATION | 1356629 = Hospital System Supply Identifier | 1082532 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1356713 = Hospital System Supply Identifier | 1082581 = 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: JVCPCT LOCATION | 1356555 = Hospital System Supply Identifier | 1082449 = 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: JVCPCT LOCATION | 1356592 = Hospital System Supply Identifier | 1082543 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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":"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: JVCPCT LOCATION | 1356846 = Hospital System Supply Identifier | 1083727 = 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: JVCPCT LOCATION | 1357224 = Hospital System Supply Identifier | 1083728 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1356992 = Hospital System Supply Identifier | 1082485 = 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: JVCPCT LOCATION | 1356984 = Hospital System Supply Identifier | 1082460 = 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: JVCPCT LOCATION | 1356960 = Hospital System Supply Identifier | 1082441 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1356672 = Hospital System Supply Identifier | 1082457 = 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: JVCPCT 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: JVCPCT LOCATION | 1055176 = Hospital System Supply Identifier | 877624 = 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: JVCPCT 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: JVCPCT LOCATION | 1055178 = Hospital System Supply Identifier | 877626 = 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: JVCPCT LOCATION | 1055179 = Hospital System Supply Identifier | 877627 = 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: JVCPCT LOCATION | 1055184 = Hospital System Supply Identifier | 877632 = 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: JVCPCT LOCATION | 1055183 = Hospital System Supply Identifier | 877631 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055182 = Hospital System Supply Identifier | 877630 = 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: JVCPCT LOCATION | 1055185 = Hospital System Supply Identifier | 877633 = 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: JVCPCT LOCATION | 1055186 = Hospital System Supply Identifier | 877634 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055191 = Hospital System Supply Identifier | 877639 = 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: JVCPCT 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: JVCPCT LOCATION | 1055188 = Hospital System Supply Identifier | 877636 = 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: JVCPCT LOCATION | 1055190 = Hospital System Supply Identifier | 877638 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055195 = Hospital System Supply Identifier | 877643 = 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: JVCPCT 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: JVCPCT LOCATION | 1055197 = Hospital System Supply Identifier | 877645 = 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: JVCPCT LOCATION | 1055198 = Hospital System Supply Identifier | 877646 = 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: JVCPCT LOCATION | 1055199 = Hospital System Supply Identifier | 877647 = 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: JVCPCT LOCATION | 1055200 = Hospital System Supply Identifier | 877648 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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":"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: JVCPCT LOCATION | 1356506 = Hospital System Supply Identifier | 1083649 = 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: JVCPCT LOCATION | 1356557 = Hospital System Supply Identifier | 1083709 = 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: JVCPCT LOCATION | 1357038 = Hospital System Supply Identifier | 1083692 = 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: JVCPCT LOCATION | 1357184 = Hospital System Supply Identifier | 1083705 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055212 = Hospital System Supply Identifier | 877660 = 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: JVCPCT 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: JVCPCT LOCATION | 1055214 = Hospital System Supply Identifier | 877662 = 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: JVCPCT 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: JVCPCT LOCATION | 1055216 = Hospital System Supply Identifier | 877664 = 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: JVCPCT LOCATION | 1055217 = Hospital System Supply Identifier | 877665 = 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: JVCPCT 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: JVCPCT LOCATION | 1055220 = Hospital System Supply Identifier | 877668 = 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: JVCPCT LOCATION | 1055218 = Hospital System Supply Identifier | 877666 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055223 = Hospital System Supply Identifier | 877671 = 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: JVCPCT LOCATION | 1055224 = Hospital System Supply Identifier | 877672 = 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: JVCPCT LOCATION | 1055225 = Hospital System Supply Identifier | 877673 = 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: JVCPCT LOCATION | 1055226 = Hospital System Supply Identifier | 877674 = 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: JVCPCT LOCATION | 1055227 = Hospital System Supply Identifier | 877675 = 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: JVCPCT LOCATION | 1055228 = Hospital System Supply Identifier | 877676 = 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: JVCPCT LOCATION | 1055233 = Hospital System Supply Identifier | 877681 = 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: JVCPCT LOCATION | 1055232 = Hospital System Supply Identifier | 877680 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055231 = Hospital System Supply Identifier | 877679 = 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: JVCPCT LOCATION | 1055235 = Hospital System Supply Identifier | 877683 = 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: JVCPCT LOCATION | 1055234 = Hospital System Supply Identifier | 877682 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055240 = Hospital System Supply Identifier | 877688 = 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: JVCPCT 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: JVCPCT LOCATION | 1055239 = Hospital System Supply Identifier | 877687 = 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: JVCPCT LOCATION | 1055237 = Hospital System Supply Identifier | 877685 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055243 = Hospital System Supply Identifier | 877691 = 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: JVCPCT LOCATION | 1055248 = Hospital System Supply Identifier | 877696 = 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: JVCPCT LOCATION | 1055247 = Hospital System Supply Identifier | 877695 = 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: JVCPCT LOCATION | 1055246 = Hospital System Supply Identifier | 877694 = 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: JVCPCT 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: JVCPCT LOCATION | 1055244 = Hospital System Supply Identifier | 877692 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055254 = Hospital System Supply Identifier | 877702 = 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: JVCPCT LOCATION | 1055251 = Hospital System Supply Identifier | 877699 = 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: JVCPCT LOCATION | 1055252 = Hospital System Supply Identifier | 877700 = 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: JVCPCT LOCATION | 1055253 = Hospital System Supply Identifier | 877701 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1356500 = Hospital System Supply Identifier | 1083662 = 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: JVCPCT LOCATION | 1055256 = Hospital System Supply Identifier | 877704 = 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: JVCPCT LOCATION | 1055257 = Hospital System Supply Identifier | 877705 = 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: JVCPCT LOCATION | 1055258 = Hospital System Supply Identifier | 877706 = 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: JVCPCT LOCATION | 1055259 = Hospital System Supply Identifier | 877707 = 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: JVCPCT LOCATION | 1055260 = Hospital System Supply Identifier | 877708 = 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: JVCPCT 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: JVCPCT LOCATION | 1055262 = Hospital System Supply Identifier | 877710 = 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: JVCPCT 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: JVCPCT LOCATION | 1055264 = Hospital System Supply Identifier | 877712 = 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: JVCPCT LOCATION | 1357204 = Hospital System Supply Identifier | 1083751 = 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: JVCPCT 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":"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: JVCPCT LOCATION | 1356764 = Hospital System Supply Identifier | 1083552 = 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: JVCPCT 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: JVCPCT LOCATION | 1055266 = Hospital System Supply Identifier | 877714 = 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: JVCPCT LOCATION | 1055267 = Hospital System Supply Identifier | 877715 = 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: JVCPCT LOCATION | 1055268 = Hospital System Supply Identifier | 877716 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055275 = Hospital System Supply Identifier | 877723 = 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: JVCPCT LOCATION | 1055273 = Hospital System Supply Identifier | 877721 = 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: JVCPCT LOCATION | 1055274 = Hospital System Supply Identifier | 877722 = 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: JVCPCT LOCATION | 1055271 = Hospital System Supply Identifier | 877719 = 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: JVCPCT LOCATION | 1055272 = Hospital System Supply Identifier | 877720 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055277 = Hospital System Supply Identifier | 877725 = 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: JVCPCT 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: JVCPCT LOCATION | 1055278 = Hospital System Supply Identifier | 877726 = 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: JVCPCT LOCATION | 1055280 = Hospital System Supply Identifier | 877728 = 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: JVCPCT LOCATION | 1055281 = Hospital System Supply Identifier | 877729 = 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: JVCPCT LOCATION | 1055282 = Hospital System Supply Identifier | 877730 = 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: JVCPCT 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: JVCPCT LOCATION | 1055283 = Hospital System Supply Identifier | 877731 = 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: JVCPCT 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: JVCPCT LOCATION | 1356950 = Hospital System Supply Identifier | 1083653 = 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: JVCPCT LOCATION | 1055284 = Hospital System Supply Identifier | 877732 = 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: JVCPCT LOCATION | 1055289 = Hospital System Supply Identifier | 877737 = 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: JVCPCT LOCATION | 1055288 = Hospital System Supply Identifier | 877736 = 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: JVCPCT LOCATION | 1055286 = Hospital System Supply Identifier | 877734 = 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: JVCPCT LOCATION | 1055287 = Hospital System Supply Identifier | 877735 = 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: JVCPCT LOCATION | 1055285 = Hospital System Supply Identifier | 877733 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055291 = Hospital System Supply Identifier | 877739 = 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055294 = Hospital System Supply Identifier | 877742 = 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: JVCPCT LOCATION | 1055295 = Hospital System Supply Identifier | 877743 = 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: JVCPCT LOCATION | 1055296 = Hospital System Supply Identifier | 877744 = 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: JVCPCT LOCATION | 1055298 = Hospital System Supply Identifier | 877746 = 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: JVCPCT 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: JVCPCT LOCATION | 1055297 = Hospital System Supply Identifier | 877745 = 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: JVCPCT 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: JVCPCT LOCATION | 1356729 = Hospital System Supply Identifier | 1083679 = 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: JVCPCT LOCATION | 1055299 = Hospital System Supply Identifier | 877747 = 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: JVCPCT LOCATION | 1055300 = Hospital System Supply Identifier | 877748 = 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: JVCPCT 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: JVCPCT LOCATION | 1055302 = Hospital System Supply Identifier | 877750 = 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: JVCPCT LOCATION | 1055303 = Hospital System Supply Identifier | 877751 = 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: JVCPCT LOCATION | 1055304 = Hospital System Supply Identifier | 877752 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055308 = Hospital System Supply Identifier | 877756 = 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: JVCPCT 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: JVCPCT LOCATION | 1055312 = Hospital System Supply Identifier | 877760 = 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: JVCPCT 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: JVCPCT LOCATION | 1055310 = Hospital System Supply Identifier | 877758 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055319 = Hospital System Supply Identifier | 877767 = 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: JVCPCT 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: JVCPCT LOCATION | 1055321 = Hospital System Supply Identifier | 877769 = 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: JVCPCT LOCATION | 1055322 = Hospital System Supply Identifier | 877770 = 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: JVCPCT LOCATION | 1055323 = Hospital System Supply Identifier | 877771 = 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: JVCPCT LOCATION | 1055327 = Hospital System Supply Identifier | 877775 = 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: JVCPCT LOCATION | 1055326 = Hospital System Supply Identifier | 877774 = 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: JVCPCT 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: JVCPCT LOCATION | 1055325 = Hospital System Supply Identifier | 877773 = 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: JVCPCT LOCATION | 1055331 = Hospital System Supply Identifier | 877779 = 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: JVCPCT LOCATION | 1055330 = Hospital System Supply Identifier | 877778 = 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: JVCPCT 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: JVCPCT LOCATION | 1055329 = Hospital System Supply Identifier | 877777 = 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: JVCPCT LOCATION | 1055332 = Hospital System Supply Identifier | 877780 = 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: JVCPCT LOCATION | 1055333 = Hospital System Supply Identifier | 877781 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1356988 = Hospital System Supply Identifier | 1083582 = 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: JVCPCT LOCATION | 1055337 = Hospital System Supply Identifier | 877785 = 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: JVCPCT LOCATION | 1055336 = Hospital System Supply Identifier | 877784 = 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: JVCPCT LOCATION | 1055340 = Hospital System Supply Identifier | 877788 = 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: JVCPCT LOCATION | 1055341 = Hospital System Supply Identifier | 877789 = 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: JVCPCT 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: JVCPCT LOCATION | 1055339 = Hospital System Supply Identifier | 877787 = 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: JVCPCT LOCATION | 1055345 = Hospital System Supply Identifier | 877793 = 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: JVCPCT LOCATION | 1055344 = Hospital System Supply Identifier | 877792 = 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: JVCPCT LOCATION | 1055343 = Hospital System Supply Identifier | 877791 = 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: JVCPCT LOCATION | 1055342 = Hospital System Supply Identifier | 877790 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055351 = Hospital System Supply Identifier | 877799 = 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: JVCPCT LOCATION | 1055352 = Hospital System Supply Identifier | 877800 = 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: JVCPCT LOCATION | 1357228 = Hospital System Supply Identifier | 1083731 = 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: JVCPCT LOCATION | 1356758 = Hospital System Supply Identifier | 1083595 = 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: JVCPCT LOCATION | 1356485 = Hospital System Supply Identifier | 1083715 = 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: JVCPCT 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":"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: JVCPCT LOCATION | 1356974 = Hospital System Supply Identifier | 1083610 = 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: JVCPCT LOCATION | 1357217 = Hospital System Supply Identifier | 1083711 = 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: JVCPCT LOCATION | 1055354 = Hospital System Supply Identifier | 877802 = 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: JVCPCT LOCATION | 1356720 = Hospital System Supply Identifier | 1083718 = 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: JVCPCT LOCATION | 1356495 = Hospital System Supply Identifier | 1082572 = 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: JVCPCT LOCATION | 1055353 = Hospital System Supply Identifier | 877801 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055358 = Hospital System Supply Identifier | 877806 = 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: JVCPCT 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: JVCPCT LOCATION | 1055360 = Hospital System Supply Identifier | 877808 = 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: JVCPCT 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: JVCPCT LOCATION | 1055362 = Hospital System Supply Identifier | 877810 = 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: JVCPCT LOCATION | 1055365 = Hospital System Supply Identifier | 877813 = 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: JVCPCT 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: JVCPCT LOCATION | 1055364 = Hospital System Supply Identifier | 877812 = 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: JVCPCT LOCATION | 1055366 = Hospital System Supply Identifier | 877814 = 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: JVCPCT LOCATION | 1055370 = Hospital System Supply Identifier | 877818 = 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: JVCPCT LOCATION | 1055369 = Hospital System Supply Identifier | 877817 = 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: JVCPCT LOCATION | 1055368 = Hospital System Supply Identifier | 877816 = 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: JVCPCT LOCATION | 1055367 = Hospital System Supply Identifier | 877815 = 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: JVCPCT LOCATION | 1055371 = Hospital System Supply Identifier | 877819 = 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: JVCPCT LOCATION | 1055372 = Hospital System Supply Identifier | 877820 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055380 = Hospital System Supply Identifier | 877828 = 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: JVCPCT LOCATION | 1055384 = Hospital System Supply Identifier | 877832 = 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: JVCPCT LOCATION | 1055383 = Hospital System Supply Identifier | 877831 = 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: JVCPCT LOCATION | 1055382 = Hospital System Supply Identifier | 877830 = 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: JVCPCT LOCATION | 1055381 = Hospital System Supply Identifier | 877829 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1055390 = Hospital System Supply Identifier | 877838 = 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: JVCPCT LOCATION | 1356756 = Hospital System Supply Identifier | 1083665 = 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: JVCPCT LOCATION | 1055391 = Hospital System Supply Identifier | 877839 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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":"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: JVCPCT 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: JVCPCT 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":"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: JVCPCT 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":"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: JVCPCT 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: JVCPCT 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":"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: JVCPCT LOCATION | 1356760 = Hospital System Supply Identifier | 1083614 = 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: JVCPCT 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: JVCPCT LOCATION | 1356381 = Hospital System Supply Identifier | 1083605 = 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: JVCPCT 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: JVCPCT LOCATION | 1357123 = Hospital System Supply Identifier | 1083618 = 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: JVCPCT 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":"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: JVCPCT LOCATION | 1356836 = Hospital System Supply Identifier | 1083697 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1357240 = Hospital System Supply Identifier | 1082497 = 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: JVCPCT LOCATION | 1356321 = Hospital System Supply Identifier | 1082519 = 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: JVCPCT LOCATION | 1356922 = Hospital System Supply Identifier | 1082558 = 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: JVCPCT LOCATION | 1357214 = Hospital System Supply Identifier | 1082565 = 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: JVCPCT LOCATION | 1357106 = Hospital System Supply Identifier | 1082455 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1357196 = Hospital System Supply Identifier | 1082589 = 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: JVCPCT LOCATION | 1357270 = Hospital System Supply Identifier | 1082454 = 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: JVCPCT LOCATION | 1356349 = Hospital System Supply Identifier | 1082463 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 1356347 = Hospital System Supply Identifier | 1082584 = 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: JVCPCT LOCATION | 1357215 = Hospital System Supply Identifier | 1082579 = 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: JVCPCT LOCATION | 1356958 = Hospital System Supply Identifier | 1082438 = 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: JVCPCT 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: JVCPCT LOCATION | 1356923 = Hospital System Supply Identifier | 1082588 = 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: JVCPCT LOCATION | 1356902 = Hospital System Supply Identifier | 1082758 = 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: JVCPCT LOCATION | 1356424 = Hospital System Supply Identifier | 1082818 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 411217 = Hospital System Supply Identifier | 459165 = 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: JVCPCT LOCATION | 411219 = Hospital System Supply Identifier | 459167 = 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: JVCPCT LOCATION | 411218 = Hospital System Supply Identifier | 459166 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 410423 = Hospital System Supply Identifier | 416866 = 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: JVCPCT LOCATION | 17233 = Hospital System Supply Identifier | 144555 = 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: JVCPCT LOCATION | 1161459 = Hospital System Supply Identifier | 1002959 = 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: JVCPCT LOCATION | 411310 = Hospital System Supply Identifier | 462060 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 407866 = Hospital System Supply Identifier | 206454 = 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: JVCPCT LOCATION | 408248 = Hospital System Supply Identifier | 303893 = 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: JVCPCT 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: JVCPCT 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: JVCPCT 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: JVCPCT LOCATION | 407492 = Hospital System Supply Identifier | 147989 = 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: JVCPCT LOCATION | 407494 = Hospital System Supply Identifier | 147991 = 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: JVCPCT 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: JVCPCT LOCATION | 149450 = Hospital System Supply Identifier | 236824 = 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: JVCPCT LOCATION | 56229 = Hospital System Supply Identifier | 208696 = 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: JVCPCT LOCATION | 407952 = Hospital System Supply Identifier | 208697 = 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: JVCPCT LOCATION | 407953 = Hospital System Supply Identifier | 208698 = 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: JVCPCT 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: JVCPCT LOCATION | 407965 = Hospital System Supply Identifier | 228835 = 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: JVCPCT 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: JVCPCT LOCATION | 407971 = Hospital System Supply Identifier | 228841 = 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: JVCPCT LOCATION | 407966 = Hospital System Supply Identifier | 228836 = 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: JVCPCT LOCATION | 407964 = Hospital System Supply Identifier | 228834 = 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: JVCPCT LOCATION | 407962 = Hospital System Supply Identifier | 228832 = 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: JVCPCT LOCATION | 407970 = Hospital System Supply Identifier | 228840 = 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: JVCPCT LOCATION | 407955 = Hospital System Supply Identifier | 208700 = 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: JVCPCT LOCATION | 407954 = Hospital System Supply Identifier | 208699 = 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: JVCPCT LOCATION | 407956 = Hospital System Supply Identifier | 208701 = 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: JVCPCT LOCATION | 56225 = Hospital System Supply Identifier | 208163 = 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: JVCPCT LOCATION | 407897 = Hospital System Supply Identifier | 208164 = 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: JVCPCT LOCATION | 407898 = Hospital System Supply Identifier | 208165 = 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: JVCPCT LOCATION | 407973 = Hospital System Supply Identifier | 228843 = 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: JVCPCT LOCATION | 407969 = Hospital System Supply Identifier | 228839 = 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: JVCPCT LOCATION | 407961 = Hospital System Supply Identifier | 228831 = 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: JVCPCT LOCATION | 407959 = Hospital System Supply Identifier | 228829 = 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: JVCPCT LOCATION | 407948 = Hospital System Supply Identifier | 208691 = 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: JVCPCT LOCATION | 56228 = Hospital System Supply Identifier | 208690 = 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: JVCPCT LOCATION | 407949 = Hospital System Supply Identifier | 208692 = 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: JVCPCT LOCATION | 407972 = Hospital System Supply Identifier | 228842 = 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: JVCPCT LOCATION | 82363 = Hospital System Supply Identifier | 208693 = 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: JVCPCT LOCATION | 407950 = Hospital System Supply Identifier | 208694 = 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: JVCPCT 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: JVCPCT LOCATION | 407960 = Hospital System Supply Identifier | 228830 = 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: JVCPCT LOCATION | 407968 = Hospital System Supply Identifier | 228838 = 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: JVCPCT LOCATION | 407974 = Hospital System Supply Identifier | 228844 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 150MM 9H RT","code_information":[{"code":"Sx00-2358-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410188","type":"LOCAL"},{"code":"410435","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 410188 = Hospital System Supply Identifier | 410435 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 98MM 5H RT","code_information":[{"code":"Sx00-2358-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"196420","type":"LOCAL"},{"code":"410434","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 196420 = Hospital System Supply Identifier | 410434 = Lawson ID"}]},{"description":"PLATE LAT LOK DST HUM 5H LT","code_information":[{"code":"Sx00-2358-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409352","type":"LOCAL"},{"code":"395448","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409352 = Hospital System Supply Identifier | 395448 = Lawson ID"}]},{"description":"PLATE HUM DIST LOK LT 9H 150","code_information":[{"code":"Sx00-2358-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"411386","type":"LOCAL"},{"code":"479626","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 411386 = Hospital System Supply Identifier | 479626 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 3H RT NS","code_information":[{"code":"Sx00-2358-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410189","type":"LOCAL"},{"code":"410436","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 410189 = Hospital System Supply Identifier | 410436 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 78MM 3H LT","code_information":[{"code":"Sx00-2358-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410190","type":"LOCAL"},{"code":"410437","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 410190 = Hospital System Supply Identifier | 410437 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 104MM 5H LT","code_information":[{"code":"Sx00-2358-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410191","type":"LOCAL"},{"code":"410438","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 410191 = Hospital System Supply Identifier | 410438 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 130MM 7H LT","code_information":[{"code":"Sx00-2358-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410192","type":"LOCAL"},{"code":"410439","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 410192 = Hospital System Supply Identifier | 410439 = Lawson ID"}]},{"description":"PLATE LOK PROX ULNA 3H RT","code_information":[{"code":"Sx00-2358-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"81267","type":"LOCAL"},{"code":"392693","type":"LOCAL"}],"standard_charges":[{"gross_charge":3356.88,"discounted_cash":1174.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 81267 = Hospital System Supply Identifier | 392693 = Lawson ID"}]},{"description":"PLATE LOK PROX ULNA 5H RT","code_information":[{"code":"Sx00-2358-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"411070","type":"LOCAL"},{"code":"433869","type":"LOCAL"}],"standard_charges":[{"gross_charge":3356.88,"discounted_cash":1174.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 411070 = Hospital System Supply Identifier | 433869 = Lawson ID"}]},{"description":"PLATE LOK PROX ULNA 5H LT","code_information":[{"code":"Sx00-2358-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"87198","type":"LOCAL"},{"code":"379064","type":"LOCAL"}],"standard_charges":[{"gross_charge":3356.88,"discounted_cash":1174.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 87198 = Hospital System Supply Identifier | 379064 = Lawson ID"}]},{"description":"PLATE LOK PROX ULNA 3H LT","code_information":[{"code":"Sx00-2358-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"195903","type":"LOCAL"},{"code":"395449","type":"LOCAL"}],"standard_charges":[{"gross_charge":3356.88,"discounted_cash":1174.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 195903 = Hospital System Supply Identifier | 395449 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 10H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408165","type":"LOCAL"},{"code":"257714","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408165 = Hospital System Supply Identifier | 257714 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 8H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408164","type":"LOCAL"},{"code":"257713","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408164 = Hospital System Supply Identifier | 257713 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 6H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408143","type":"LOCAL"},{"code":"257692","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408143 = Hospital System Supply Identifier | 257692 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 12H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408166","type":"LOCAL"},{"code":"257715","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408166 = Hospital System Supply Identifier | 257715 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 3H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408141","type":"LOCAL"},{"code":"257690","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408141 = Hospital System Supply Identifier | 257690 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 2H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408140","type":"LOCAL"},{"code":"257689","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408140 = Hospital System Supply Identifier | 257689 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 4H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408142","type":"LOCAL"},{"code":"257691","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408142 = Hospital System Supply Identifier | 257691 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 2H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408144","type":"LOCAL"},{"code":"257693","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408144 = Hospital System Supply Identifier | 257693 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 3H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408145","type":"LOCAL"},{"code":"257694","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408145 = Hospital System Supply Identifier | 257694 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 4H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408146","type":"LOCAL"},{"code":"257695","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408146 = Hospital System Supply Identifier | 257695 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 6H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408147","type":"LOCAL"},{"code":"257696","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408147 = Hospital System Supply Identifier | 257696 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 8H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408167","type":"LOCAL"},{"code":"257716","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408167 = Hospital System Supply Identifier | 257716 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 10H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408168","type":"LOCAL"},{"code":"257717","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408168 = Hospital System Supply Identifier | 257717 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 12H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408169","type":"LOCAL"},{"code":"257718","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408169 = Hospital System Supply Identifier | 257718 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 6H RT","code_information":[{"code":"Sx00-2358-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408151","type":"LOCAL"},{"code":"257700","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408151 = Hospital System Supply Identifier | 257700 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 4H RT","code_information":[{"code":"Sx00-2358-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408150","type":"LOCAL"},{"code":"257699","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408150 = Hospital System Supply Identifier | 257699 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 2H RT","code_information":[{"code":"Sx00-2358-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408148","type":"LOCAL"},{"code":"257697","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408148 = Hospital System Supply Identifier | 257697 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 3H RT","code_information":[{"code":"Sx00-2358-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408149","type":"LOCAL"},{"code":"257698","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408149 = Hospital System Supply Identifier | 257698 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 2H LT","code_information":[{"code":"Sx00-2358-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408152","type":"LOCAL"},{"code":"257701","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408152 = Hospital System Supply Identifier | 257701 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 3H LT","code_information":[{"code":"Sx00-2358-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408153","type":"LOCAL"},{"code":"257702","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408153 = Hospital System Supply Identifier | 257702 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 4H LT","code_information":[{"code":"Sx00-2358-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408154","type":"LOCAL"},{"code":"257703","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408154 = Hospital System Supply Identifier | 257703 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 6H LT","code_information":[{"code":"Sx00-2358-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408155","type":"LOCAL"},{"code":"257704","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408155 = Hospital System Supply Identifier | 257704 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 8H RT","code_information":[{"code":"Sx00-2358-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408170","type":"LOCAL"},{"code":"257719","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408170 = Hospital System Supply Identifier | 257719 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 10H RT","code_information":[{"code":"Sx00-2358-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408171","type":"LOCAL"},{"code":"257720","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408171 = Hospital System Supply Identifier | 257720 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 6H RT","code_information":[{"code":"Sx00-2358-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408159","type":"LOCAL"},{"code":"257708","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408159 = Hospital System Supply Identifier | 257708 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 3H RT","code_information":[{"code":"Sx00-2358-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408157","type":"LOCAL"},{"code":"257706","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408157 = Hospital System Supply Identifier | 257706 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 4H RT","code_information":[{"code":"Sx00-2358-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408158","type":"LOCAL"},{"code":"257707","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408158 = Hospital System Supply Identifier | 257707 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 2H RT","code_information":[{"code":"Sx00-2358-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408156","type":"LOCAL"},{"code":"257705","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408156 = Hospital System Supply Identifier | 257705 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 2H LT","code_information":[{"code":"Sx00-2358-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408160","type":"LOCAL"},{"code":"257709","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408160 = Hospital System Supply Identifier | 257709 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 3H LT","code_information":[{"code":"Sx00-2358-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408161","type":"LOCAL"},{"code":"257710","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408161 = Hospital System Supply Identifier | 257710 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 4H LT","code_information":[{"code":"Sx00-2358-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408162","type":"LOCAL"},{"code":"257711","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408162 = Hospital System Supply Identifier | 257711 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 6H LT","code_information":[{"code":"Sx00-2358-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408163","type":"LOCAL"},{"code":"257712","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408163 = Hospital System Supply Identifier | 257712 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 8H LT","code_information":[{"code":"Sx00-2358-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"193228","type":"LOCAL"},{"code":"257721","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193228 = Hospital System Supply Identifier | 257721 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 10H LT","code_information":[{"code":"Sx00-2358-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408172","type":"LOCAL"},{"code":"257722","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408172 = Hospital System Supply Identifier | 257722 = Lawson ID"}]},{"description":"PLATE LAT LOK DST HUM 7H RT","code_information":[{"code":"Sx00-2358-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409354","type":"LOCAL"},{"code":"395451","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409354 = Hospital System Supply Identifier | 395451 = Lawson ID"}]},{"description":"PLATE LAT LOK DST HUM 5H RT","code_information":[{"code":"Sx00-2358-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409353","type":"LOCAL"},{"code":"395450","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409353 = Hospital System Supply Identifier | 395450 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 5H LT","code_information":[{"code":"Sx00-2358-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410193","type":"LOCAL"},{"code":"410440","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 410193 = Hospital System Supply Identifier | 410440 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 9H LT","code_information":[{"code":"Sx00-2358-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410194","type":"LOCAL"},{"code":"410441","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 410194 = Hospital System Supply Identifier | 410441 = Lawson ID"}]},{"description":"DISC - PLATE LOK RAD DST 52MM 2H RT","code_information":[{"code":"Sx00-2358-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410195","type":"LOCAL"},{"code":"410442","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 410195 = Hospital System Supply Identifier | 410442 = Lawson ID"}]},{"description":"DISC - PLATE LOK RAD DST 74MM 4H RT","code_information":[{"code":"Sx00-2358-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410196","type":"LOCAL"},{"code":"410443","type":"LOCAL"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1596.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 410196 = Hospital System Supply Identifier | 410443 = Lawson ID"}]},{"description":"PLATE LOK DST HUM 7H RT","code_information":[{"code":"Sx00-2358-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409355","type":"LOCAL"},{"code":"395452","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409355 = Hospital System Supply Identifier | 395452 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 74MM 3H RT","code_information":[{"code":"Sx00-2358-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410197","type":"LOCAL"},{"code":"410444","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 410197 = Hospital System Supply Identifier | 410444 = Lawson ID"}]},{"description":"PLATE LOK PERI HD/LM 7HL 126MM","code_information":[{"code":"Sx00-2358-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410541","type":"LOCAL"},{"code":"432322","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 410541 = Hospital System Supply Identifier | 432322 = Lawson ID"}]},{"description":"PLATE LOK DST HUM 3H LT","code_information":[{"code":"Sx00-2358-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409356","type":"LOCAL"},{"code":"395453","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409356 = Hospital System Supply Identifier | 395453 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 100MM 5H LT","code_information":[{"code":"Sx00-2358-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410198","type":"LOCAL"},{"code":"410445","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 410198 = Hospital System Supply Identifier | 410445 = Lawson ID"}]},{"description":"SCREW CNCL 2.7X40MM","code_information":[{"code":"Sx00-2359-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410457","type":"LOCAL"},{"code":"419227","type":"LOCAL"}],"standard_charges":[{"gross_charge":260.1,"discounted_cash":91.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 410457 = Hospital System Supply Identifier | 419227 = Lawson ID"}]},{"description":"GWIRE 1.6MM DRL TIP","code_information":[{"code":"Sx00-2360-033","type":"CDM"},{"code":"272","type":"RC"},{"code":"57445","type":"LOCAL"},{"code":"312606","type":"LOCAL"}],"standard_charges":[{"gross_charge":279.45,"discounted_cash":97.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 57445 = Hospital System Supply Identifier | 312606 = Lawson ID"}]},{"description":"GWIRE ORTH SMTH DRL 1.6X229MM","code_information":[{"code":"Sx00-2360-036","type":"CDM"},{"code":"272","type":"RC"},{"code":"409627","type":"LOCAL"},{"code":"402351","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409627 = Hospital System Supply Identifier | 402351 = Lawson ID"}]},{"description":"BIT DRILL CANN STD 4.7MM","code_information":[{"code":"Sx00-2360-071","type":"CDM"},{"code":"272","type":"RC"},{"code":"202228","type":"LOCAL"},{"code":"452326","type":"LOCAL"}],"standard_charges":[{"gross_charge":679.65,"discounted_cash":237.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202228 = Hospital System Supply Identifier | 452326 = Lawson ID"}]},{"description":"BIT DRILL STD CANN Q/C 2.7MM","code_information":[{"code":"Sx00-2360-171","type":"CDM"},{"code":"272","type":"RC"},{"code":"193551","type":"LOCAL"},{"code":"312612","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.3,"discounted_cash":199.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193551 = Hospital System Supply Identifier | 312612 = Lawson ID"}]},{"description":"BIT DRILL STD CANN 2.0MM","code_information":[{"code":"Sx00-2360-175","type":"CDM"},{"code":"272","type":"RC"},{"code":"178409","type":"LOCAL"},{"code":"337133","type":"LOCAL"}],"standard_charges":[{"gross_charge":462.95,"discounted_cash":162.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178409 = Hospital System Supply Identifier | 337133 = Lawson ID"}]},{"description":"BIT DRILL STD CANN 2.7MM","code_information":[{"code":"Sx00-2360-205","type":"CDM"},{"code":"272","type":"RC"},{"code":"178308","type":"LOCAL"},{"code":"312608","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.1,"discounted_cash":89.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178308 = Hospital System Supply Identifier | 312608 = Lawson ID"}]},{"description":"BIT DRILL STD CANN 3.7MM","code_information":[{"code":"Sx00-2360-225","type":"CDM"},{"code":"272","type":"RC"},{"code":"153603","type":"LOCAL"},{"code":"294680","type":"LOCAL"}],"standard_charges":[{"gross_charge":492.5,"discounted_cash":172.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 153603 = Hospital System Supply Identifier | 294680 = Lawson ID"}]},{"description":"NO USAGE - BIT DRILL AO 1.8X45MM","code_information":[{"code":"Sx00-2366-030","type":"CDM"},{"code":"272","type":"RC"},{"code":"411335","type":"LOCAL"},{"code":"462085","type":"LOCAL"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 411335 = Hospital System Supply Identifier | 462085 = Lawson ID"}]},{"description":"NO USAGE - BIT DRILL AO 2.4X45MM","code_information":[{"code":"Sx00-2366-030","type":"CDM"},{"code":"272","type":"RC"},{"code":"411336","type":"LOCAL"},{"code":"462086","type":"LOCAL"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":183.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 411336 = Hospital System Supply Identifier | 462086 = Lawson ID"}]},{"description":"BIT DRILL Q/C 2.5X216MM","code_information":[{"code":"Sx00-2410-029","type":"CDM"},{"code":"272","type":"RC"},{"code":"16209","type":"LOCAL"},{"code":"129466","type":"LOCAL"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 16209 = Hospital System Supply Identifier | 129466 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X10MM","code_information":[{"code":"Sx00-2480-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17849","type":"LOCAL"},{"code":"157489","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.1,"discounted_cash":38.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 17849 = Hospital System Supply Identifier | 157489 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X18MM","code_information":[{"code":"Sx00-2480-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17856","type":"LOCAL"},{"code":"157497","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.1,"discounted_cash":38.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 17856 = Hospital System Supply Identifier | 157497 = Lawson ID"}]},{"description":"SCREW CANC FORTE F/T 4X18MM","code_information":[{"code":"Sx00-2480-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17857","type":"LOCAL"},{"code":"157498","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.1,"discounted_cash":38.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 17857 = Hospital System Supply Identifier | 157498 = Lawson ID"}]},{"description":"SCREW CANC FORTE F/T 4X22MM","code_information":[{"code":"Sx00-2480-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33316","type":"LOCAL"},{"code":"157502","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.1,"discounted_cash":38.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 33316 = Hospital System Supply Identifier | 157502 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X22MM","code_information":[{"code":"Sx00-2480-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33315","type":"LOCAL"},{"code":"157501","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.1,"discounted_cash":38.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 33315 = Hospital System Supply Identifier | 157501 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X24MM","code_information":[{"code":"Sx00-2480-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"34322","type":"LOCAL"},{"code":"157503","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.1,"discounted_cash":38.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 34322 = Hospital System Supply Identifier | 157503 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X26MM","code_information":[{"code":"Sx00-2480-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33317","type":"LOCAL"},{"code":"157505","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.1,"discounted_cash":38.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 33317 = Hospital System Supply Identifier | 157505 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X28MM","code_information":[{"code":"Sx00-2480-028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33319","type":"LOCAL"},{"code":"157507","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.1,"discounted_cash":38.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 33319 = Hospital System Supply Identifier | 157507 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X30MM","code_information":[{"code":"Sx00-2480-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17860","type":"LOCAL"},{"code":"157509","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.1,"discounted_cash":38.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 17860 = Hospital System Supply Identifier | 157509 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X32MM","code_information":[{"code":"Sx00-2480-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33322","type":"LOCAL"},{"code":"157511","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.1,"discounted_cash":38.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 33322 = Hospital System Supply Identifier | 157511 = Lawson ID"}]},{"description":"SCREW CANC FORTE F/T 4X32MM","code_information":[{"code":"Sx00-2480-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33323","type":"LOCAL"},{"code":"157512","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.1,"discounted_cash":38.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 33323 = Hospital System Supply Identifier | 157512 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X34MM","code_information":[{"code":"Sx00-2480-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33324","type":"LOCAL"},{"code":"157513","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.1,"discounted_cash":38.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 33324 = Hospital System Supply Identifier | 157513 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X36MM","code_information":[{"code":"Sx00-2480-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33326","type":"LOCAL"},{"code":"157515","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.1,"discounted_cash":38.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 33326 = Hospital System Supply Identifier | 157515 = Lawson ID"}]},{"description":"SCREW CANC FORTE F/T 4X36MM","code_information":[{"code":"Sx00-2480-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33327","type":"LOCAL"},{"code":"157516","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.1,"discounted_cash":38.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 33327 = Hospital System Supply Identifier | 157516 = Lawson ID"}]},{"description":"SCREW CANC FORTE F/T 4X38MM","code_information":[{"code":"Sx00-2480-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33329","type":"LOCAL"},{"code":"157518","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.1,"discounted_cash":38.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 33329 = Hospital System Supply Identifier | 157518 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X38MM","code_information":[{"code":"Sx00-2480-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33328","type":"LOCAL"},{"code":"157517","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.1,"discounted_cash":38.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 33328 = Hospital System Supply Identifier | 157517 = Lawson ID"}]},{"description":"PIN THRD 3X305MM","code_information":[{"code":"Sx00-2490-012","type":"CDM"},{"code":"272","type":"RC"},{"code":"360769","type":"LOCAL"},{"code":"389703","type":"LOCAL"}],"standard_charges":[{"gross_charge":420.55,"discounted_cash":147.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 360769 = Hospital System Supply Identifier | 389703 = Lawson ID"}]},{"description":"BIT DRILL CANN FEMUR RF 4.9MM","code_information":[{"code":"Sx00-2490-034","type":"CDM"},{"code":"272","type":"RC"},{"code":"409358","type":"LOCAL"},{"code":"395456","type":"LOCAL"}],"standard_charges":[{"gross_charge":1829.95,"discounted_cash":640.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409358 = Hospital System Supply Identifier | 395456 = Lawson ID"}]},{"description":"PIN NAT N-THRD 3.0X355MM","code_information":[{"code":"Sx00-2490-047","type":"CDM"},{"code":"272","type":"RC"},{"code":"409151","type":"LOCAL"},{"code":"393312","type":"LOCAL"}],"standard_charges":[{"gross_charge":436.8,"discounted_cash":152.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409151 = Hospital System Supply Identifier | 393312 = Lawson ID"}]},{"description":"DRILL FREE HAND 4.3MM RED","code_information":[{"code":"Sx00-2490-075","type":"CDM"},{"code":"272","type":"RC"},{"code":"360773","type":"LOCAL"},{"code":"391784","type":"LOCAL"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 360773 = Hospital System Supply Identifier | 391784 = Lawson ID"}]},{"description":"PLATE LOK PROX ULNA 7H RT","code_information":[{"code":"Sx00-2538-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"743176","type":"LOCAL"},{"code":"574913","type":"LOCAL"}],"standard_charges":[{"gross_charge":3356.88,"discounted_cash":1174.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 743176 = Hospital System Supply Identifier | 574913 = Lawson ID"}]},{"description":"PIN STNMN THRD STYLE 5 2.0X229","code_information":[{"code":"Sx00-2620-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"725565","type":"LOCAL"},{"code":"737012","type":"LOCAL"}],"standard_charges":[{"gross_charge":79.94,"discounted_cash":27.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 725565 = Hospital System Supply Identifier | 737012 = Lawson ID"}]},{"description":"PLATE L1 ORTHANC FLAT TAB 4H","code_information":[{"code":"Sx00-301-12-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"779933","type":"LOCAL"},{"code":"773378","type":"LOCAL"}],"standard_charges":[{"gross_charge":936.6,"discounted_cash":327.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 779933 = Hospital System Supply Identifier | 773378 = Lawson ID"}]},{"description":"PLATE L1 ORTHANC FLAT TAB 4H","code_information":[{"code":"Sx00-301-14-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"779934","type":"LOCAL"},{"code":"773379","type":"LOCAL"}],"standard_charges":[{"gross_charge":923.65,"discounted_cash":323.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 779934 = Hospital System Supply Identifier | 773379 = Lawson ID"}]},{"description":"PLATE L1 ORTHANC FLAT TAB 4H","code_information":[{"code":"Sx00-301-17-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"779935","type":"LOCAL"},{"code":"773380","type":"LOCAL"}],"standard_charges":[{"gross_charge":923.65,"discounted_cash":323.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 779935 = Hospital System Supply Identifier | 773380 = Lawson ID"}]},{"description":"FLEXFOAM STRIP 3INX25YD","code_information":[{"code":"Sx00-3861-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"391624","type":"LOCAL"},{"code":"255268","type":"LOCAL"}],"standard_charges":[{"gross_charge":272.95,"discounted_cash":95.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 391624 = Hospital System Supply Identifier | 255268 = Lawson ID"}]},{"description":"RESTRICTOR CEMENT 32MM STRL TRABECULAR METAL HIP ACETABULAR","code_information":[{"code":"Sx00-4199-001","type":"CDM"},{"code":"272","type":"RC"},{"code":"314881","type":"LOCAL"},{"code":"530002","type":"LOCAL"}],"standard_charges":[{"gross_charge":4389.0,"discounted_cash":1536.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 314881 = Hospital System Supply Identifier | 530002 = Lawson ID"}]},{"description":"IMP HIP ACET RSTRCT 38MM","code_information":[{"code":"Sx00-4199-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326713","type":"LOCAL"},{"code":"408140","type":"LOCAL"}],"standard_charges":[{"gross_charge":4389.0,"discounted_cash":1536.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326713 = Hospital System Supply Identifier | 408140 = Lawson ID"}]},{"description":"RESTRICTOR CEM ACET TM 26MM","code_information":[{"code":"Sx00-4199-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"330133","type":"LOCAL"},{"code":"418233","type":"LOCAL"}],"standard_charges":[{"gross_charge":4389.0,"discounted_cash":1536.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 330133 = Hospital System Supply Identifier | 418233 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM6X60MM","code_information":[{"code":"Sx00-4300-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302862","type":"LOCAL"},{"code":"521806","type":"LOCAL"}],"standard_charges":[{"gross_charge":7756.87,"discounted_cash":2714.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302862 = Hospital System Supply Identifier | 521806 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM6X130MM","code_information":[{"code":"Sx00-4300-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302863","type":"LOCAL"},{"code":"521807","type":"LOCAL"}],"standard_charges":[{"gross_charge":7756.87,"discounted_cash":2714.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302863 = Hospital System Supply Identifier | 521807 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 7X130MM","code_information":[{"code":"Sx00-4300-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323283","type":"LOCAL"},{"code":"153980","type":"LOCAL"}],"standard_charges":[{"gross_charge":7756.87,"discounted_cash":2714.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 323283 = Hospital System Supply Identifier | 153980 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM BGLN 7","code_information":[{"code":"Sx00-4300-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"86088","type":"LOCAL"},{"code":"305404","type":"LOCAL"}],"standard_charges":[{"gross_charge":7756.87,"discounted_cash":2714.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 86088 = Hospital System Supply Identifier | 305404 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM8X200MM","code_information":[{"code":"Sx00-4300-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302865","type":"LOCAL"},{"code":"521809","type":"LOCAL"}],"standard_charges":[{"gross_charge":11711.17,"discounted_cash":4098.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302865 = Hospital System Supply Identifier | 521809 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 8X130MM","code_information":[{"code":"Sx00-4300-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"166657","type":"LOCAL"},{"code":"147867","type":"LOCAL"}],"standard_charges":[{"gross_charge":7756.87,"discounted_cash":2714.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 166657 = Hospital System Supply Identifier | 147867 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM8X170MM","code_information":[{"code":"Sx00-4300-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302864","type":"LOCAL"},{"code":"521808","type":"LOCAL"}],"standard_charges":[{"gross_charge":7756.87,"discounted_cash":2714.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302864 = Hospital System Supply Identifier | 521808 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 9X130MM","code_information":[{"code":"Sx00-4300-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"35400","type":"LOCAL"},{"code":"153062","type":"LOCAL"}],"standard_charges":[{"gross_charge":7756.87,"discounted_cash":2714.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 35400 = Hospital System Supply Identifier | 153062 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 10X130","code_information":[{"code":"Sx00-4300-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"35393","type":"LOCAL"},{"code":"151511","type":"LOCAL"}],"standard_charges":[{"gross_charge":7756.87,"discounted_cash":2714.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 35393 = Hospital System Supply Identifier | 151511 = Lawson ID"}]},{"description":"IMP SHLDR-T HUM STEM 10X170","code_information":[{"code":"Sx00-4300-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329906","type":"LOCAL"},{"code":"398068","type":"LOCAL"}],"standard_charges":[{"gross_charge":7756.87,"discounted_cash":2714.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329906 = Hospital System Supply Identifier | 398068 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM10X200MM","code_information":[{"code":"Sx00-4300-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302866","type":"LOCAL"},{"code":"521810","type":"LOCAL"}],"standard_charges":[{"gross_charge":11711.17,"discounted_cash":4098.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302866 = Hospital System Supply Identifier | 521810 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 11X130","code_information":[{"code":"Sx00-4300-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"35425","type":"LOCAL"},{"code":"156812","type":"LOCAL"}],"standard_charges":[{"gross_charge":7756.87,"discounted_cash":2714.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 35425 = Hospital System Supply Identifier | 156812 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM12X200MM","code_information":[{"code":"Sx00-4300-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302867","type":"LOCAL"},{"code":"521811","type":"LOCAL"}],"standard_charges":[{"gross_charge":11711.17,"discounted_cash":4098.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302867 = Hospital System Supply Identifier | 521811 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 12X170","code_information":[{"code":"Sx00-4300-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326233","type":"LOCAL"},{"code":"391786","type":"LOCAL"}],"standard_charges":[{"gross_charge":7756.87,"discounted_cash":2714.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326233 = Hospital System Supply Identifier | 391786 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 12X130","code_information":[{"code":"Sx00-4300-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"92890","type":"LOCAL"},{"code":"148416","type":"LOCAL"}],"standard_charges":[{"gross_charge":7756.87,"discounted_cash":2714.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 92890 = Hospital System Supply Identifier | 148416 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM BGLN 13","code_information":[{"code":"Sx00-4300-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"94002","type":"LOCAL"},{"code":"232672","type":"LOCAL"}],"standard_charges":[{"gross_charge":7756.87,"discounted_cash":2714.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 94002 = Hospital System Supply Identifier | 232672 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM BGLN 14","code_information":[{"code":"Sx00-4300-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"149470","type":"LOCAL"},{"code":"236852","type":"LOCAL"}],"standard_charges":[{"gross_charge":7756.87,"discounted_cash":2714.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 149470 = Hospital System Supply Identifier | 236852 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM14X170MM","code_information":[{"code":"Sx00-4300-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302868","type":"LOCAL"},{"code":"521812","type":"LOCAL"}],"standard_charges":[{"gross_charge":7756.87,"discounted_cash":2714.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302868 = Hospital System Supply Identifier | 521812 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM14X200MM","code_information":[{"code":"Sx00-4300-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302869","type":"LOCAL"},{"code":"521813","type":"LOCAL"}],"standard_charges":[{"gross_charge":11711.17,"discounted_cash":4098.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302869 = Hospital System Supply Identifier | 521813 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 15X130","code_information":[{"code":"Sx00-4300-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"35482","type":"LOCAL"},{"code":"158629","type":"LOCAL"}],"standard_charges":[{"gross_charge":7756.87,"discounted_cash":2714.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 35482 = Hospital System Supply Identifier | 158629 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 16X130","code_information":[{"code":"Sx00-4300-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"150051","type":"LOCAL"},{"code":"237743","type":"LOCAL"}],"standard_charges":[{"gross_charge":7756.87,"discounted_cash":2714.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 150051 = Hospital System Supply Identifier | 237743 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM17X130MM","code_information":[{"code":"Sx00-4300-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302870","type":"LOCAL"},{"code":"521814","type":"LOCAL"}],"standard_charges":[{"gross_charge":7756.87,"discounted_cash":2714.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302870 = Hospital System Supply Identifier | 521814 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM18X130MM","code_information":[{"code":"Sx00-4300-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302871","type":"LOCAL"},{"code":"521815","type":"LOCAL"}],"standard_charges":[{"gross_charge":7756.87,"discounted_cash":2714.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302871 = Hospital System Supply Identifier | 521815 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 27X40MM","code_information":[{"code":"Sx00-4300-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302873","type":"LOCAL"},{"code":"521817","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302873 = Hospital System Supply Identifier | 521817 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 15X40MM","code_information":[{"code":"Sx00-4300-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302872","type":"LOCAL"},{"code":"521816","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302872 = Hospital System Supply Identifier | 521816 = Lawson ID"}]},{"description":"IMP GLEN COMP 46MM W/KEEL","code_information":[{"code":"Sx00-4300-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324794","type":"LOCAL"},{"code":"323988","type":"LOCAL"}],"standard_charges":[{"gross_charge":3782.4,"discounted_cash":1323.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 324794 = Hospital System Supply Identifier | 323988 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 40X24MM","code_information":[{"code":"Sx00-4300-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323285","type":"LOCAL"},{"code":"160249","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 323285 = Hospital System Supply Identifier | 160249 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD BGLN 40","code_information":[{"code":"Sx00-4300-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"149556","type":"LOCAL"},{"code":"236968","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 149556 = Hospital System Supply Identifier | 236968 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM BGLN 40","code_information":[{"code":"Sx00-4300-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"151456","type":"LOCAL"},{"code":"254477","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 151456 = Hospital System Supply Identifier | 254477 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 30X46MM","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302876","type":"LOCAL"},{"code":"521820","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302876 = Hospital System Supply Identifier | 521820 = Lawson ID"}]},{"description":"IMP GLEN COMP 40MM W/KEEL","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302878","type":"LOCAL"},{"code":"521822","type":"LOCAL"}],"standard_charges":[{"gross_charge":3782.4,"discounted_cash":1323.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302878 = Hospital System Supply Identifier | 521822 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 33X46MM","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302877","type":"LOCAL"},{"code":"521821","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302877 = Hospital System Supply Identifier | 521821 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 27X46MM","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302875","type":"LOCAL"},{"code":"521819","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302875 = Hospital System Supply Identifier | 521819 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 46X15MM","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"84819","type":"LOCAL"},{"code":"236915","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 84819 = Hospital System Supply Identifier | 236915 = Lawson ID"}]},{"description":"IMP GLEN COMP 52MM W/KEEL","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324795","type":"LOCAL"},{"code":"323989","type":"LOCAL"}],"standard_charges":[{"gross_charge":3782.4,"discounted_cash":1323.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 324795 = Hospital System Supply Identifier | 323989 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 46X18MM","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328899","type":"LOCAL"},{"code":"153742","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 328899 = Hospital System Supply Identifier | 153742 = Lawson ID"}]},{"description":"HEAD HUMERAL","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"92891","type":"LOCAL"},{"code":"148417","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 92891 = Hospital System Supply Identifier | 148417 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 24X46MM","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302874","type":"LOCAL"},{"code":"521818","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302874 = Hospital System Supply Identifier | 521818 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 52X24MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167071","type":"LOCAL"},{"code":"157719","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 167071 = Hospital System Supply Identifier | 157719 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 52X21MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329144","type":"LOCAL"},{"code":"253622","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329144 = Hospital System Supply Identifier | 253622 = Lawson ID"}]},{"description":"IMP HEAD STD GLEN 52X18MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326247","type":"LOCAL"},{"code":"392780","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326247 = Hospital System Supply Identifier | 392780 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD 27X52MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302879","type":"LOCAL"},{"code":"521823","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302879 = Hospital System Supply Identifier | 521823 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 30X52MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302880","type":"LOCAL"},{"code":"521824","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302880 = Hospital System Supply Identifier | 521824 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 33X52MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302881","type":"LOCAL"},{"code":"521825","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302881 = Hospital System Supply Identifier | 521825 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 36X52MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302882","type":"LOCAL"},{"code":"521826","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302882 = Hospital System Supply Identifier | 521826 = Lawson ID"}]},{"description":"IMP SHLDR GLEN 52MM 46MM SURF","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302883","type":"LOCAL"},{"code":"521827","type":"LOCAL"}],"standard_charges":[{"gross_charge":3782.4,"discounted_cash":1323.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302883 = Hospital System Supply Identifier | 521827 = Lawson ID"}]},{"description":"IMP SHLDR GLEN 52MM 56MM SURF","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302884","type":"LOCAL"},{"code":"521828","type":"LOCAL"}],"standard_charges":[{"gross_charge":3782.4,"discounted_cash":1323.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302884 = Hospital System Supply Identifier | 521828 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD 42X56MM","code_information":[{"code":"Sx00-4300-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302889","type":"LOCAL"},{"code":"521833","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302889 = Hospital System Supply Identifier | 521833 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD 39X56MM","code_information":[{"code":"Sx00-4300-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302888","type":"LOCAL"},{"code":"521832","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302888 = Hospital System Supply Identifier | 521832 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD 33X56MM","code_information":[{"code":"Sx00-4300-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302886","type":"LOCAL"},{"code":"521830","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302886 = Hospital System Supply Identifier | 521830 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD 30X56MM","code_information":[{"code":"Sx00-4300-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302885","type":"LOCAL"},{"code":"521829","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302885 = Hospital System Supply Identifier | 521829 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD 36X56MM","code_information":[{"code":"Sx00-4300-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302887","type":"LOCAL"},{"code":"521831","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302887 = Hospital System Supply Identifier | 521831 = Lawson ID"}]},{"description":"IMP SHLDR GLEN KEEL 40MM","code_information":[{"code":"Sx00-4300-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302890","type":"LOCAL"},{"code":"521834","type":"LOCAL"}],"standard_charges":[{"gross_charge":3782.4,"discounted_cash":1323.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302890 = Hospital System Supply Identifier | 521834 = Lawson ID"}]},{"description":"IMP SHLDR-T GLEN BGFW 46MM","code_information":[{"code":"Sx00-4300-081","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329887","type":"LOCAL"},{"code":"395459","type":"LOCAL"}],"standard_charges":[{"gross_charge":3782.4,"discounted_cash":1323.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329887 = Hospital System Supply Identifier | 395459 = Lawson ID"}]},{"description":"IMP SHLDR TOT GLEN BGFW 52MM","code_information":[{"code":"Sx00-4300-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325542","type":"LOCAL"},{"code":"353753","type":"LOCAL"}],"standard_charges":[{"gross_charge":3782.4,"discounted_cash":1323.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325542 = Hospital System Supply Identifier | 353753 = Lawson ID"}]},{"description":"IMP SHLDR GLEN COMP BGLN 85MM","code_information":[{"code":"Sx00-4300-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145802","type":"LOCAL"},{"code":"237455","type":"LOCAL"}],"standard_charges":[{"gross_charge":3782.4,"discounted_cash":1323.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145802 = Hospital System Supply Identifier | 237455 = Lawson ID"}]},{"description":"IMP SHLDR GLEN COMP BGLN 86MM","code_information":[{"code":"Sx00-4300-086","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169816","type":"LOCAL"},{"code":"329977","type":"LOCAL"}],"standard_charges":[{"gross_charge":3782.4,"discounted_cash":1323.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 169816 = Hospital System Supply Identifier | 329977 = Lawson ID"}]},{"description":"IMP SHLDR GLEN COMP BGLN 52MM","code_information":[{"code":"Sx00-4300-087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145775","type":"LOCAL"},{"code":"236851","type":"LOCAL"}],"standard_charges":[{"gross_charge":3782.4,"discounted_cash":1323.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145775 = Hospital System Supply Identifier | 236851 = Lawson ID"}]},{"description":"PIN ALIGN SMTH BLNT SS 3X300MM","code_information":[{"code":"Sx00-4301-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"35338","type":"LOCAL"},{"code":"147898","type":"LOCAL"}],"standard_charges":[{"gross_charge":368.4,"discounted_cash":128.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 35338 = Hospital System Supply Identifier | 147898 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 27X40","code_information":[{"code":"Sx00-4302-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302903","type":"LOCAL"},{"code":"521847","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302903 = Hospital System Supply Identifier | 521847 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 24X40","code_information":[{"code":"Sx00-4302-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302902","type":"LOCAL"},{"code":"521846","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302902 = Hospital System Supply Identifier | 521846 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 15X40","code_information":[{"code":"Sx00-4302-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302901","type":"LOCAL"},{"code":"521845","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302901 = Hospital System Supply Identifier | 521845 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 40X21","code_information":[{"code":"Sx00-4302-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145918","type":"LOCAL"},{"code":"294860","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145918 = Hospital System Supply Identifier | 294860 = Lawson ID"}]},{"description":"IMP SHLDR GLEN HD BGLN 40X46MM","code_information":[{"code":"Sx00-4302-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145772","type":"LOCAL"},{"code":"236653","type":"LOCAL"}],"standard_charges":[{"gross_charge":3782.4,"discounted_cash":1323.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145772 = Hospital System Supply Identifier | 236653 = Lawson ID"}]},{"description":"HEAD HUM OFFSET 18X40MM","code_information":[{"code":"Sx00-4302-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"166038","type":"LOCAL"},{"code":"386846","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 166038 = Hospital System Supply Identifier | 386846 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 27X46","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302904","type":"LOCAL"},{"code":"521848","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302904 = Hospital System Supply Identifier | 521848 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 46X18","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"35406","type":"LOCAL"},{"code":"153981","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 35406 = Hospital System Supply Identifier | 153981 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 46X21","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145617","type":"LOCAL"},{"code":"154319","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145617 = Hospital System Supply Identifier | 154319 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 46X19","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"147838","type":"LOCAL"},{"code":"232671","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 147838 = Hospital System Supply Identifier | 232671 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 46X17","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145738","type":"LOCAL"},{"code":"235655","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145738 = Hospital System Supply Identifier | 235655 = Lawson ID"}]},{"description":"IMP SHLDR GLEN BGLN PEGS 46X52","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145763","type":"LOCAL"},{"code":"236319","type":"LOCAL"}],"standard_charges":[{"gross_charge":3782.4,"discounted_cash":1323.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145763 = Hospital System Supply Identifier | 236319 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 46X23","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"94782","type":"LOCAL"},{"code":"294264","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 94782 = Hospital System Supply Identifier | 294264 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 46X15","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325140","type":"LOCAL"},{"code":"338927","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325140 = Hospital System Supply Identifier | 338927 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD BGFW 24X46MM","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326290","type":"LOCAL"},{"code":"395461","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326290 = Hospital System Supply Identifier | 395461 = Lawson ID"}]},{"description":"IMP SHLDR GLEN PEG BF 46MM","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"171789","type":"LOCAL"},{"code":"439192","type":"LOCAL"}],"standard_charges":[{"gross_charge":3782.4,"discounted_cash":1323.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 171789 = Hospital System Supply Identifier | 439192 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 30X46","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302905","type":"LOCAL"},{"code":"521849","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302905 = Hospital System Supply Identifier | 521849 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X30","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328644","type":"LOCAL"},{"code":"462716","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 328644 = Hospital System Supply Identifier | 462716 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X27","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"161396","type":"LOCAL"},{"code":"357149","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 161396 = Hospital System Supply Identifier | 357149 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 33X52","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302906","type":"LOCAL"},{"code":"521850","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302906 = Hospital System Supply Identifier | 521850 = Lawson ID"}]},{"description":"IMP SHLDR GLEN COMP W/PEG 46MM","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146146","type":"LOCAL"},{"code":"337461","type":"LOCAL"}],"standard_charges":[{"gross_charge":3782.4,"discounted_cash":1323.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146146 = Hospital System Supply Identifier | 337461 = Lawson ID"}]},{"description":"IMP SHLDR GLEN COMP W/PEG 52MM","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"171776","type":"LOCAL"},{"code":"425659","type":"LOCAL"}],"standard_charges":[{"gross_charge":3782.4,"discounted_cash":1323.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 171776 = Hospital System Supply Identifier | 425659 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X19","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145762","type":"LOCAL"},{"code":"236316","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145762 = Hospital System Supply Identifier | 236316 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X24","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167143","type":"LOCAL"},{"code":"158630","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 167143 = Hospital System Supply Identifier | 158630 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X18","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145748","type":"LOCAL"},{"code":"235970","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145748 = Hospital System Supply Identifier | 235970 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X23","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145818","type":"LOCAL"},{"code":"237742","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145818 = Hospital System Supply Identifier | 237742 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X21","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"94073","type":"LOCAL"},{"code":"236039","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 94073 = Hospital System Supply Identifier | 236039 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 56X21","code_information":[{"code":"Sx00-4302-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"170077","type":"LOCAL"},{"code":"380776","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 170077 = Hospital System Supply Identifier | 380776 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 56X19","code_information":[{"code":"Sx00-4302-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329809","type":"LOCAL"},{"code":"382420","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329809 = Hospital System Supply Identifier | 382420 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD OFF BF 23X56","code_information":[{"code":"Sx00-4302-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326196","type":"LOCAL"},{"code":"386279","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326196 = Hospital System Supply Identifier | 386279 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 56X27","code_information":[{"code":"Sx00-4302-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"330494","type":"LOCAL"},{"code":"455945","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 330494 = Hospital System Supply Identifier | 455945 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD OFFS 24X56MM","code_information":[{"code":"Sx00-4302-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"171790","type":"LOCAL"},{"code":"439193","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 171790 = Hospital System Supply Identifier | 439193 = Lawson ID"}]},{"description":"BIT DRILL BIGLIANI FLATOW TRABECULAR METAL 00430704200 2.5MM","code_information":[{"code":"Sx00-4307-042","type":"CDM"},{"code":"272","type":"RC"},{"code":"1446394","type":"LOCAL"},{"code":"1002289","type":"LOCAL"}],"standard_charges":[{"gross_charge":1487.12,"discounted_cash":520.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1446394 = Hospital System Supply Identifier | 1002289 = Lawson ID"}]},{"description":"BIT DRILL BIGLIANI FLATOW TRABECULAR METAL 00430704300 2.5MM","code_information":[{"code":"Sx00-4307-043","type":"CDM"},{"code":"272","type":"RC"},{"code":"1446396","type":"LOCAL"},{"code":"1002296","type":"LOCAL"}],"standard_charges":[{"gross_charge":2268.45,"discounted_cash":793.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1446396 = Hospital System Supply Identifier | 1002296 = Lawson ID"}]},{"description":"ROD THRD ALIGN TM","code_information":[{"code":"Sx00-4309-009","type":"CDM"},{"code":"272","type":"RC"},{"code":"842102","type":"LOCAL"},{"code":"705155","type":"LOCAL"}],"standard_charges":[{"gross_charge":433.4,"discounted_cash":151.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842102 = Hospital System Supply Identifier | 705155 = Lawson ID"}]},{"description":"BIT DRILL TRABECULAR METAL 00430904515 7.5X15MM","code_information":[{"code":"Sx00-4309-045","type":"CDM"},{"code":"272","type":"RC"},{"code":"1446397","type":"LOCAL"},{"code":"1002366","type":"LOCAL"}],"standard_charges":[{"gross_charge":886.5,"discounted_cash":310.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1446397 = Hospital System Supply Identifier | 1002366 = Lawson ID"}]},{"description":"BIT DRILL TRABECULAR METAL 00430904530 7.5X30MM","code_information":[{"code":"Sx00-4309-045","type":"CDM"},{"code":"272","type":"RC"},{"code":"1446398","type":"LOCAL"},{"code":"1002389","type":"LOCAL"}],"standard_charges":[{"gross_charge":886.5,"discounted_cash":310.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1446398 = Hospital System Supply Identifier | 1002389 = Lawson ID"}]},{"description":"BIT DRILL CANNULATED REVERSE TRABECULAR METAL 00430904615 7.5X15MM","code_information":[{"code":"Sx00-4309-046","type":"CDM"},{"code":"272","type":"RC"},{"code":"1414749","type":"LOCAL"},{"code":"1089894","type":"LOCAL"}],"standard_charges":[{"gross_charge":886.5,"discounted_cash":310.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1414749 = Hospital System Supply Identifier | 1089894 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 6X130MM","code_information":[{"code":"Sx00-4342-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302925","type":"LOCAL"},{"code":"521869","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302925 = Hospital System Supply Identifier | 521869 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 8X170MM","code_information":[{"code":"Sx00-4342-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302927","type":"LOCAL"},{"code":"521871","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302927 = Hospital System Supply Identifier | 521871 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 8X130MM","code_information":[{"code":"Sx00-4342-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302926","type":"LOCAL"},{"code":"521870","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302926 = Hospital System Supply Identifier | 521870 = Lawson ID"}]},{"description":"IMP SHLDR FEM STEM TM 9X130MM","code_information":[{"code":"Sx00-4342-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326292","type":"LOCAL"},{"code":"395464","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326292 = Hospital System Supply Identifier | 395464 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 10X130","code_information":[{"code":"Sx00-4342-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326293","type":"LOCAL"},{"code":"395465","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326293 = Hospital System Supply Identifier | 395465 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 10X170","code_information":[{"code":"Sx00-4342-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302928","type":"LOCAL"},{"code":"521872","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302928 = Hospital System Supply Identifier | 521872 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 11X130","code_information":[{"code":"Sx00-4342-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154624","type":"LOCAL"},{"code":"298394","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154624 = Hospital System Supply Identifier | 298394 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 12X130","code_information":[{"code":"Sx00-4342-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178416","type":"LOCAL"},{"code":"337466","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178416 = Hospital System Supply Identifier | 337466 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 12X170","code_information":[{"code":"Sx00-4342-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"330224","type":"LOCAL"},{"code":"427929","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 330224 = Hospital System Supply Identifier | 427929 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 12X130","code_information":[{"code":"Sx00-4342-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325118","type":"LOCAL"},{"code":"337467","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325118 = Hospital System Supply Identifier | 337467 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 14X170","code_information":[{"code":"Sx00-4342-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302929","type":"LOCAL"},{"code":"521873","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302929 = Hospital System Supply Identifier | 521873 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 14X130","code_information":[{"code":"Sx00-4342-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325119","type":"LOCAL"},{"code":"337468","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325119 = Hospital System Supply Identifier | 337468 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 15X130","code_information":[{"code":"Sx00-4342-115","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"439879","type":"LOCAL"},{"code":"329976","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 439879 = Hospital System Supply Identifier | 329976 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 16X170","code_information":[{"code":"Sx00-4342-116","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325541","type":"LOCAL"},{"code":"353752","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325541 = Hospital System Supply Identifier | 353752 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 17X130","code_information":[{"code":"Sx00-4342-117","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302930","type":"LOCAL"},{"code":"521874","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302930 = Hospital System Supply Identifier | 521874 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 18X130","code_information":[{"code":"Sx00-4342-118","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"170076","type":"LOCAL"},{"code":"380775","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 170076 = Hospital System Supply Identifier | 380775 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 48D 6X130MM","code_information":[{"code":"Sx00-4348-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302931","type":"LOCAL"},{"code":"521875","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302931 = Hospital System Supply Identifier | 521875 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 48D 8X170MM","code_information":[{"code":"Sx00-4348-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302932","type":"LOCAL"},{"code":"521876","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302932 = Hospital System Supply Identifier | 521876 = Lawson ID"}]},{"description":"IMP SHLDR FEM STEM TM 8X130M","code_information":[{"code":"Sx00-4348-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325444","type":"LOCAL"},{"code":"347343","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325444 = Hospital System Supply Identifier | 347343 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM TM 9X130","code_information":[{"code":"Sx00-4348-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"153645","type":"LOCAL"},{"code":"294859","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 153645 = Hospital System Supply Identifier | 294859 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 48D 10X170","code_information":[{"code":"Sx00-4348-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302933","type":"LOCAL"},{"code":"521877","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302933 = Hospital System Supply Identifier | 521877 = Lawson ID"}]},{"description":"IMP SHLDR STEM HUM TM 10X130","code_information":[{"code":"Sx00-4348-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146191","type":"LOCAL"},{"code":"353527","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146191 = Hospital System Supply Identifier | 353527 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM TM 48DEG 11","code_information":[{"code":"Sx00-4348-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326084","type":"LOCAL"},{"code":"382516","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326084 = Hospital System Supply Identifier | 382516 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 48D 12X170","code_information":[{"code":"Sx00-4348-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302934","type":"LOCAL"},{"code":"521878","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302934 = Hospital System Supply Identifier | 521878 = Lawson ID"}]},{"description":"IMP SHLDR STEM HUM TM 12X130","code_information":[{"code":"Sx00-4348-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146255","type":"LOCAL"},{"code":"362853","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146255 = Hospital System Supply Identifier | 362853 = Lawson ID"}]},{"description":"IMP SHLDR STEM HUM TM 13X130","code_information":[{"code":"Sx00-4348-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146073","type":"LOCAL"},{"code":"315005","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146073 = Hospital System Supply Identifier | 315005 = Lawson ID"}]},{"description":"IMP SHLDR STEM HUM TM 14X130","code_information":[{"code":"Sx00-4348-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326193","type":"LOCAL"},{"code":"384917","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326193 = Hospital System Supply Identifier | 384917 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 48D 14X170","code_information":[{"code":"Sx00-4348-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302935","type":"LOCAL"},{"code":"521879","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302935 = Hospital System Supply Identifier | 521879 = Lawson ID"}]},{"description":"IMP SHLDR STEM HUM TM 15X130","code_information":[{"code":"Sx00-4348-115","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145909","type":"LOCAL"},{"code":"294265","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145909 = Hospital System Supply Identifier | 294265 = Lawson ID"}]},{"description":"IMP SHLD HUM STEM 16X130 48DEG","code_information":[{"code":"Sx00-4348-116","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146213","type":"LOCAL"},{"code":"357148","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146213 = Hospital System Supply Identifier | 357148 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 48DEG 17MM","code_information":[{"code":"Sx00-4348-117","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325934","type":"LOCAL"},{"code":"372115","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325934 = Hospital System Supply Identifier | 372115 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM TM 48DEG 18","code_information":[{"code":"Sx00-4348-118","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326082","type":"LOCAL"},{"code":"382419","type":"LOCAL"}],"standard_charges":[{"gross_charge":7999.45,"discounted_cash":2799.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326082 = Hospital System Supply Identifier | 382419 = Lawson ID"}]},{"description":"IMP SHLDR STEM REV TM 8X130MM","code_information":[{"code":"Sx00-4349-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329888","type":"LOCAL"},{"code":"395466","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329888 = Hospital System Supply Identifier | 395466 = Lawson ID"}]},{"description":"IMP STEM HUM REV TM 8X170MM","code_information":[{"code":"Sx00-4349-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"181640","type":"LOCAL"},{"code":"453439","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 181640 = Hospital System Supply Identifier | 453439 = Lawson ID"}]},{"description":"IMP HUM STEM REV 10X130MM","code_information":[{"code":"Sx00-4349-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178417","type":"LOCAL"},{"code":"337469","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178417 = Hospital System Supply Identifier | 337469 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 10X170","code_information":[{"code":"Sx00-4349-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302936","type":"LOCAL"},{"code":"521880","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302936 = Hospital System Supply Identifier | 521880 = Lawson ID"}]},{"description":"IMP SHLDR STEM REV TM 12X130MM","code_information":[{"code":"Sx00-4349-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178418","type":"LOCAL"},{"code":"337470","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178418 = Hospital System Supply Identifier | 337470 = Lawson ID"}]},{"description":"IMP SHLDR STEM REV TM 12X170MM","code_information":[{"code":"Sx00-4349-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325120","type":"LOCAL"},{"code":"337471","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325120 = Hospital System Supply Identifier | 337471 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 14MM","code_information":[{"code":"Sx00-4349-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146148","type":"LOCAL"},{"code":"337472","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146148 = Hospital System Supply Identifier | 337472 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 14X170","code_information":[{"code":"Sx00-4349-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302937","type":"LOCAL"},{"code":"521881","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302937 = Hospital System Supply Identifier | 521881 = Lawson ID"}]},{"description":"IMP SHLDR CAP BSPLT TM 15MM","code_information":[{"code":"Sx00-4349-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178831","type":"LOCAL"},{"code":"416161","type":"LOCAL"}],"standard_charges":[{"gross_charge":4561.8,"discounted_cash":1596.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178831 = Hospital System Supply Identifier | 416161 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 16X130","code_information":[{"code":"Sx00-4349-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302938","type":"LOCAL"},{"code":"521882","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302938 = Hospital System Supply Identifier | 521882 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 16X170","code_information":[{"code":"Sx00-4349-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302939","type":"LOCAL"},{"code":"521883","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302939 = Hospital System Supply Identifier | 521883 = Lawson ID"}]},{"description":"IMP SHLDR REV STEM TM 18X130MM","code_information":[{"code":"Sx00-4349-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328540","type":"LOCAL"},{"code":"458212","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 328540 = Hospital System Supply Identifier | 458212 = Lawson ID"}]},{"description":"IMP SHLDR BSPLT REV 25MM POS","code_information":[{"code":"Sx00-4349-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302940","type":"LOCAL"},{"code":"521884","type":"LOCAL"}],"standard_charges":[{"gross_charge":4561.8,"discounted_cash":1596.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302940 = Hospital System Supply Identifier | 521884 = Lawson ID"}]},{"description":"IMP SHLDR BSPLT REV 30MM POS","code_information":[{"code":"Sx00-4349-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302941","type":"LOCAL"},{"code":"521885","type":"LOCAL"}],"standard_charges":[{"gross_charge":4561.8,"discounted_cash":1596.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302941 = Hospital System Supply Identifier | 521885 = Lawson ID"}]},{"description":"IMP LNR HUM INS TM REV 36X6MM","code_information":[{"code":"Sx00-4349-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178420","type":"LOCAL"},{"code":"337475","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178420 = Hospital System Supply Identifier | 337475 = Lawson ID"}]},{"description":"IMP SHLDR GLEN 36MM","code_information":[{"code":"Sx00-4349-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146150","type":"LOCAL"},{"code":"337476","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146150 = Hospital System Supply Identifier | 337476 = Lawson ID"}]},{"description":"IMP LNR HUM INS TM REV 36MM","code_information":[{"code":"Sx00-4349-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146149","type":"LOCAL"},{"code":"337473","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146149 = Hospital System Supply Identifier | 337473 = Lawson ID"}]},{"description":"IMP LNR HUM INS TM PLS 36MM","code_information":[{"code":"Sx00-4349-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178419","type":"LOCAL"},{"code":"337474","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178419 = Hospital System Supply Identifier | 337474 = Lawson ID"}]},{"description":"IMP SHLDR HUM INS 37X0MM","code_information":[{"code":"Sx00-4349-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325121","type":"LOCAL"},{"code":"337477","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325121 = Hospital System Supply Identifier | 337477 = Lawson ID"}]},{"description":"IMP SHLDR SPCR TRAB MTL 9MM","code_information":[{"code":"Sx00-4349-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146152","type":"LOCAL"},{"code":"337479","type":"LOCAL"}],"standard_charges":[{"gross_charge":1930.6,"discounted_cash":675.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146152 = Hospital System Supply Identifier | 337479 = Lawson ID"}]},{"description":"IMP SPCR TRABCLR MTL 12MM","code_information":[{"code":"Sx00-4349-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169959","type":"LOCAL"},{"code":"360582","type":"LOCAL"}],"standard_charges":[{"gross_charge":1930.6,"discounted_cash":675.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 169959 = Hospital System Supply Identifier | 360582 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS6 40MM","code_information":[{"code":"Sx00-4349-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302943","type":"LOCAL"},{"code":"521887","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302943 = Hospital System Supply Identifier | 521887 = Lawson ID"}]},{"description":"IMP SHLDR GLEN TM REV 40MM","code_information":[{"code":"Sx00-4349-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325638","type":"LOCAL"},{"code":"360583","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325638 = Hospital System Supply Identifier | 360583 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS 40X0MM","code_information":[{"code":"Sx00-4349-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326390","type":"LOCAL"},{"code":"398116","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326390 = Hospital System Supply Identifier | 398116 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS3 40MM","code_information":[{"code":"Sx00-4349-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302942","type":"LOCAL"},{"code":"521886","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302942 = Hospital System Supply Identifier | 521886 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS 6 65D 36","code_information":[{"code":"Sx00-4349-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325641","type":"LOCAL"},{"code":"360587","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325641 = Hospital System Supply Identifier | 360587 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS0 65D 36M","code_information":[{"code":"Sx00-4349-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"786996","type":"LOCAL"},{"code":"459002","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 786996 = Hospital System Supply Identifier | 459002 = Lawson ID"}]},{"description":"IMP LNR TM REV POLY 36MM 3","code_information":[{"code":"Sx00-4349-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325640","type":"LOCAL"},{"code":"360586","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325640 = Hospital System Supply Identifier | 360586 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS0 65D 40M","code_information":[{"code":"Sx00-4349-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"841469","type":"LOCAL"},{"code":"459445","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 841469 = Hospital System Supply Identifier | 459445 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS3 65D 40","code_information":[{"code":"Sx00-4349-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302944","type":"LOCAL"},{"code":"521888","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302944 = Hospital System Supply Identifier | 521888 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS6 65D 40","code_information":[{"code":"Sx00-4349-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302945","type":"LOCAL"},{"code":"521889","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302945 = Hospital System Supply Identifier | 521889 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 6X13","code_information":[{"code":"Sx00-4350-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302946","type":"LOCAL"},{"code":"521890","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302946 = Hospital System Supply Identifier | 521890 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 8X13","code_information":[{"code":"Sx00-4350-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302947","type":"LOCAL"},{"code":"521891","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302947 = Hospital System Supply Identifier | 521891 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 8X20","code_information":[{"code":"Sx00-4350-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302948","type":"LOCAL"},{"code":"521892","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302948 = Hospital System Supply Identifier | 521892 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 9X13","code_information":[{"code":"Sx00-4350-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302949","type":"LOCAL"},{"code":"521893","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302949 = Hospital System Supply Identifier | 521893 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 10X20","code_information":[{"code":"Sx00-4350-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302951","type":"LOCAL"},{"code":"521895","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302951 = Hospital System Supply Identifier | 521895 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 10X1","code_information":[{"code":"Sx00-4350-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302950","type":"LOCAL"},{"code":"521894","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302950 = Hospital System Supply Identifier | 521894 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 11X1","code_information":[{"code":"Sx00-4350-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302952","type":"LOCAL"},{"code":"521896","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302952 = Hospital System Supply Identifier | 521896 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 12X1","code_information":[{"code":"Sx00-4350-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302953","type":"LOCAL"},{"code":"521897","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302953 = Hospital System Supply Identifier | 521897 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 12X20","code_information":[{"code":"Sx00-4350-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302954","type":"LOCAL"},{"code":"521898","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302954 = Hospital System Supply Identifier | 521898 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 13X1","code_information":[{"code":"Sx00-4350-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302955","type":"LOCAL"},{"code":"521899","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302955 = Hospital System Supply Identifier | 521899 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 14X1","code_information":[{"code":"Sx00-4350-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302956","type":"LOCAL"},{"code":"521900","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302956 = Hospital System Supply Identifier | 521900 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 14X20","code_information":[{"code":"Sx00-4350-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302957","type":"LOCAL"},{"code":"521901","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302957 = Hospital System Supply Identifier | 521901 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 15X1","code_information":[{"code":"Sx00-4350-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302958","type":"LOCAL"},{"code":"521902","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302958 = Hospital System Supply Identifier | 521902 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 16X20","code_information":[{"code":"Sx00-4350-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302960","type":"LOCAL"},{"code":"521904","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302960 = Hospital System Supply Identifier | 521904 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 16X1","code_information":[{"code":"Sx00-4350-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302959","type":"LOCAL"},{"code":"521903","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302959 = Hospital System Supply Identifier | 521903 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 18X1","code_information":[{"code":"Sx00-4350-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302961","type":"LOCAL"},{"code":"521905","type":"LOCAL"}],"standard_charges":[{"gross_charge":11605.18,"discounted_cash":4061.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 302961 = Hospital System Supply Identifier | 521905 = Lawson ID"}]},{"description":"IMP SHLDR LNR XLNK POLY 35MM","code_information":[{"code":"Sx00-4350-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"841946","type":"LOCAL"},{"code":"663511","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 841946 = Hospital System Supply Identifier | 663511 = Lawson ID"}]},{"description":"IMP SHLDR LNR XLNK PLS 336MM","code_information":[{"code":"Sx00-4350-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"841947","type":"LOCAL"},{"code":"665299","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 841947 = Hospital System Supply Identifier | 665299 = Lawson ID"}]},{"description":"IMP SHLDR LNR VIT E 36MM PLS6","code_information":[{"code":"Sx00-4350-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842103","type":"LOCAL"},{"code":"705156","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842103 = Hospital System Supply Identifier | 705156 = Lawson ID"}]},{"description":"IMP SHLDR LNR VIT E 40MM PLS0","code_information":[{"code":"Sx00-4350-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842104","type":"LOCAL"},{"code":"705157","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842104 = Hospital System Supply Identifier | 705157 = Lawson ID"}]},{"description":"IMP SHLDR LNR VIT E 40MM PLS3","code_information":[{"code":"Sx00-4350-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842105","type":"LOCAL"},{"code":"705158","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842105 = Hospital System Supply Identifier | 705158 = Lawson ID"}]},{"description":"IMP SHLDR LNR VIT E 40MM PLS6","code_information":[{"code":"Sx00-4350-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842106","type":"LOCAL"},{"code":"705159","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842106 = Hospital System Supply Identifier | 705159 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR 3MM OFFSET","code_information":[{"code":"Sx00-4350-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"841945","type":"LOCAL"},{"code":"659495","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 841945 = Hospital System Supply Identifier | 659495 = Lawson ID"}]},{"description":"IMP LNR 65D RET VIT E 36MM PL0","code_information":[{"code":"Sx00-4350-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842107","type":"LOCAL"},{"code":"705160","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842107 = Hospital System Supply Identifier | 705160 = Lawson ID"}]},{"description":"IMP LNR 65D RET VIT E 36MM PL6","code_information":[{"code":"Sx00-4350-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842108","type":"LOCAL"},{"code":"705161","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842108 = Hospital System Supply Identifier | 705161 = Lawson ID"}]},{"description":"IMP LNR 65D RET VIT E 40MM PL0","code_information":[{"code":"Sx00-4350-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842109","type":"LOCAL"},{"code":"705162","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842109 = Hospital System Supply Identifier | 705162 = Lawson ID"}]},{"description":"IMP LNR 65D RET VIT E 40MM PL3","code_information":[{"code":"Sx00-4350-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842110","type":"LOCAL"},{"code":"705163","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842110 = Hospital System Supply Identifier | 705163 = Lawson ID"}]},{"description":"IMP LNR 65D RET VIT E 40MM PL6","code_information":[{"code":"Sx00-4350-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842111","type":"LOCAL"},{"code":"705164","type":"LOCAL"}],"standard_charges":[{"gross_charge":3191.42,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842111 = Hospital System Supply Identifier | 705164 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS0MM 36MM","code_information":[{"code":"Sx00-4360-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842115","type":"LOCAL"},{"code":"777519","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842115 = Hospital System Supply Identifier | 777519 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS2MM 36MM","code_information":[{"code":"Sx00-4360-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842116","type":"LOCAL"},{"code":"777520","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842116 = Hospital System Supply Identifier | 777520 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS0MM 40MM","code_information":[{"code":"Sx00-4360-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842117","type":"LOCAL"},{"code":"777521","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842117 = Hospital System Supply Identifier | 777521 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS2.5MM 40MM","code_information":[{"code":"Sx00-4360-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842118","type":"LOCAL"},{"code":"777522","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842118 = Hospital System Supply Identifier | 777522 = Lawson ID"}]},{"description":"BIT DRILL TRABECULAR METAL REVERSE PLUS 00436104515 7.5X15MM","code_information":[{"code":"Sx00-4361-045","type":"CDM"},{"code":"272","type":"RC"},{"code":"1446399","type":"LOCAL"},{"code":"1002374","type":"LOCAL"}],"standard_charges":[{"gross_charge":1448.12,"discounted_cash":506.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1446399 = Hospital System Supply Identifier | 1002374 = Lawson ID"}]},{"description":"BIT DRILL TRABECULAR METAL REVERSE PLUS 00436104525 7.5X25MM","code_information":[{"code":"Sx00-4361-045","type":"CDM"},{"code":"272","type":"RC"},{"code":"1446400","type":"LOCAL"},{"code":"1002281","type":"LOCAL"}],"standard_charges":[{"gross_charge":1448.12,"discounted_cash":506.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1446400 = Hospital System Supply Identifier | 1002281 = Lawson ID"}]},{"description":"BIT DRILL REVERSE SHOULDER TRABECULAR METAL 00436107330 7.5X30MM","code_information":[{"code":"Sx00-4361-073","type":"CDM"},{"code":"272","type":"RC"},{"code":"1414750","type":"LOCAL"},{"code":"1089674","type":"LOCAL"}],"standard_charges":[{"gross_charge":731.35,"discounted_cash":255.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1414750 = Hospital System Supply Identifier | 1089674 = Lawson ID"}]},{"description":"BIT DRILL REVERSE SHOULDER TRABECULAR METAL 00436107325 7.5X25MM","code_information":[{"code":"Sx00-4361-073","type":"CDM"},{"code":"272","type":"RC"},{"code":"1414751","type":"LOCAL"},{"code":"1089841","type":"LOCAL"}],"standard_charges":[{"gross_charge":731.35,"discounted_cash":255.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1414751 = Hospital System Supply Identifier | 1089841 = Lawson ID"}]},{"description":"BIT DRILL REVERSE SHOULDER TRABECULAR METAL 00436107320 7.5X20MM","code_information":[{"code":"Sx00-4361-073","type":"CDM"},{"code":"272","type":"RC"},{"code":"1414753","type":"LOCAL"},{"code":"1089856","type":"LOCAL"}],"standard_charges":[{"gross_charge":731.35,"discounted_cash":255.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1414753 = Hospital System Supply Identifier | 1089856 = Lawson ID"}]},{"description":"BIT DRILL TRABECULAR METAL 00436107315 7.5X15MM","code_information":[{"code":"Sx00-4361-073","type":"CDM"},{"code":"272","type":"RC"},{"code":"1414754","type":"LOCAL"},{"code":"1090098","type":"LOCAL"}],"standard_charges":[{"gross_charge":731.35,"discounted_cash":255.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1414754 = Hospital System Supply Identifier | 1090098 = Lawson ID"}]},{"description":"BASEPLATE GLEN REV 15X26MM","code_information":[{"code":"Sx00-4362-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842119","type":"LOCAL"},{"code":"777523","type":"LOCAL"}],"standard_charges":[{"gross_charge":4561.8,"discounted_cash":1596.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842119 = Hospital System Supply Identifier | 777523 = Lawson ID"}]},{"description":"BASEPLATE GLEN REV 20X26MM","code_information":[{"code":"Sx00-4362-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842120","type":"LOCAL"},{"code":"777524","type":"LOCAL"}],"standard_charges":[{"gross_charge":4561.8,"discounted_cash":1596.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842120 = Hospital System Supply Identifier | 777524 = Lawson ID"}]},{"description":"BASEPLATE GLEN REV 25X26MM","code_information":[{"code":"Sx00-4362-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842121","type":"LOCAL"},{"code":"777525","type":"LOCAL"}],"standard_charges":[{"gross_charge":4561.8,"discounted_cash":1596.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842121 = Hospital System Supply Identifier | 777525 = Lawson ID"}]},{"description":"BASEPLATE GLEN REV 30X26MM","code_information":[{"code":"Sx00-4362-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842122","type":"LOCAL"},{"code":"777526","type":"LOCAL"}],"standard_charges":[{"gross_charge":4561.8,"discounted_cash":1596.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842122 = Hospital System Supply Identifier | 777526 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS3MM 36MM","code_information":[{"code":"Sx00-4363-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842123","type":"LOCAL"},{"code":"777527","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842123 = Hospital System Supply Identifier | 777527 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS3MM ECC 36MM","code_information":[{"code":"Sx00-4363-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842124","type":"LOCAL"},{"code":"777528","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842124 = Hospital System Supply Identifier | 777528 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS3MM 40MM","code_information":[{"code":"Sx00-4363-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842125","type":"LOCAL"},{"code":"777529","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842125 = Hospital System Supply Identifier | 777529 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS3MM ECC 40MM","code_information":[{"code":"Sx00-4363-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842126","type":"LOCAL"},{"code":"777530","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842126 = Hospital System Supply Identifier | 777530 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS5MM 36MM","code_information":[{"code":"Sx00-4365-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842127","type":"LOCAL"},{"code":"777531","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842127 = Hospital System Supply Identifier | 777531 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS5MM ECC 36MM","code_information":[{"code":"Sx00-4365-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842128","type":"LOCAL"},{"code":"777532","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842128 = Hospital System Supply Identifier | 777532 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS5MM 40MM","code_information":[{"code":"Sx00-4365-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842129","type":"LOCAL"},{"code":"777533","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842129 = Hospital System Supply Identifier | 777533 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS5MM ECC 40MM","code_information":[{"code":"Sx00-4365-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842130","type":"LOCAL"},{"code":"777534","type":"LOCAL"}],"standard_charges":[{"gross_charge":4210.87,"discounted_cash":1473.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 842130 = Hospital System Supply Identifier | 777534 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450001100 SIZE 1","code_information":[{"code":"Sx00-4500-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482088","type":"LOCAL"},{"code":"1100786","type":"LOCAL"}],"standard_charges":[{"gross_charge":24360.0,"discounted_cash":8526.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482088 = Hospital System Supply Identifier | 1100786 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450001400 SIZE 4","code_information":[{"code":"Sx00-4500-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482069","type":"LOCAL"},{"code":"1100803","type":"LOCAL"}],"standard_charges":[{"gross_charge":24360.0,"discounted_cash":8526.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482069 = Hospital System Supply Identifier | 1100803 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450001500 SIZE 5","code_information":[{"code":"Sx00-4500-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482087","type":"LOCAL"},{"code":"1100782","type":"LOCAL"}],"standard_charges":[{"gross_charge":24360.0,"discounted_cash":8526.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482087 = Hospital System Supply Identifier | 1100782 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450001600 SIZE 6","code_information":[{"code":"Sx00-4500-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482067","type":"LOCAL"},{"code":"1100806","type":"LOCAL"}],"standard_charges":[{"gross_charge":24360.0,"discounted_cash":8526.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482067 = Hospital System Supply Identifier | 1100806 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450002100 SIZE 1","code_information":[{"code":"Sx00-4500-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482095","type":"LOCAL"},{"code":"1100784","type":"LOCAL"}],"standard_charges":[{"gross_charge":24360.0,"discounted_cash":8526.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482095 = Hospital System Supply Identifier | 1100784 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450002200 SIZE 2","code_information":[{"code":"Sx00-4500-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482099","type":"LOCAL"},{"code":"1100789","type":"LOCAL"}],"standard_charges":[{"gross_charge":24360.0,"discounted_cash":8526.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482099 = Hospital System Supply Identifier | 1100789 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450002300 SIZE 3","code_information":[{"code":"Sx00-4500-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482066","type":"LOCAL"},{"code":"1100792","type":"LOCAL"}],"standard_charges":[{"gross_charge":24360.0,"discounted_cash":8526.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482066 = Hospital System Supply Identifier | 1100792 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450002400 SIZE 4","code_information":[{"code":"Sx00-4500-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482079","type":"LOCAL"},{"code":"1100817","type":"LOCAL"}],"standard_charges":[{"gross_charge":24360.0,"discounted_cash":8526.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482079 = Hospital System Supply Identifier | 1100817 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450002500 SIZE 5","code_information":[{"code":"Sx00-4500-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482092","type":"LOCAL"},{"code":"1100801","type":"LOCAL"}],"standard_charges":[{"gross_charge":24360.0,"discounted_cash":8526.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482092 = Hospital System Supply Identifier | 1100801 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450002600 SIZE 6","code_information":[{"code":"Sx00-4500-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482072","type":"LOCAL"},{"code":"1100813","type":"LOCAL"}],"standard_charges":[{"gross_charge":24360.0,"discounted_cash":8526.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482072 = Hospital System Supply Identifier | 1100813 = Lawson ID"}]},{"description":"ANKLE JOINT TIBIAL COMPONENT TRABECULAR METAL 00450004100 SIZE 1","code_information":[{"code":"Sx00-4500-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482061","type":"LOCAL"},{"code":"1100797","type":"LOCAL"}],"standard_charges":[{"gross_charge":18568.0,"discounted_cash":6498.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482061 = Hospital System Supply Identifier | 1100797 = Lawson ID"}]},{"description":"ANKLE JOINT TIBIAL COMPONENT TRABECULAR METAL 00450004400 SIZE 4","code_information":[{"code":"Sx00-4500-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482077","type":"LOCAL"},{"code":"1100808","type":"LOCAL"}],"standard_charges":[{"gross_charge":18568.0,"discounted_cash":6498.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482077 = Hospital System Supply Identifier | 1100808 = Lawson ID"}]},{"description":"ANKLE JOINT TIBIAL COMPONENT TRABECULAR METAL 00450004500 SIZE 5","code_information":[{"code":"Sx00-4500-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482063","type":"LOCAL"},{"code":"1100780","type":"LOCAL"}],"standard_charges":[{"gross_charge":18568.0,"discounted_cash":6498.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482063 = Hospital System Supply Identifier | 1100780 = Lawson ID"}]},{"description":"ANKLE JOINT TIBIAL COMPONENT TRABECULAR METAL 00450004600 SIZE 6","code_information":[{"code":"Sx00-4500-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482093","type":"LOCAL"},{"code":"1100810","type":"LOCAL"}],"standard_charges":[{"gross_charge":18568.0,"discounted_cash":6498.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482093 = Hospital System Supply Identifier | 1100810 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005102 2 SIZE 1","code_information":[{"code":"Sx00-4500-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482085","type":"LOCAL"},{"code":"1100804","type":"LOCAL"}],"standard_charges":[{"gross_charge":10005.0,"discounted_cash":3501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482085 = Hospital System Supply Identifier | 1100804 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005100 0 SIZE 1","code_information":[{"code":"Sx00-4500-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482101","type":"LOCAL"},{"code":"1100824","type":"LOCAL"}],"standard_charges":[{"gross_charge":10005.0,"discounted_cash":3501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482101 = Hospital System Supply Identifier | 1100824 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005104 4 SIZE 1","code_information":[{"code":"Sx00-4500-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482097","type":"LOCAL"},{"code":"1100812","type":"LOCAL"}],"standard_charges":[{"gross_charge":10005.0,"discounted_cash":3501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482097 = Hospital System Supply Identifier | 1100812 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005204 4 SIZE 2","code_information":[{"code":"Sx00-4500-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482064","type":"LOCAL"},{"code":"1100805","type":"LOCAL"}],"standard_charges":[{"gross_charge":10005.0,"discounted_cash":3501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482064 = Hospital System Supply Identifier | 1100805 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005202 2 SIZE 2","code_information":[{"code":"Sx00-4500-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482081","type":"LOCAL"},{"code":"1100791","type":"LOCAL"}],"standard_charges":[{"gross_charge":10005.0,"discounted_cash":3501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482081 = Hospital System Supply Identifier | 1100791 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005302 2 SIZE 3","code_information":[{"code":"Sx00-4500-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482078","type":"LOCAL"},{"code":"1100820","type":"LOCAL"}],"standard_charges":[{"gross_charge":10005.0,"discounted_cash":3501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482078 = Hospital System Supply Identifier | 1100820 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005304 4 SIZE 3","code_information":[{"code":"Sx00-4500-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482086","type":"LOCAL"},{"code":"1100821","type":"LOCAL"}],"standard_charges":[{"gross_charge":10005.0,"discounted_cash":3501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482086 = Hospital System Supply Identifier | 1100821 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005402 2 SIZE 4","code_information":[{"code":"Sx00-4500-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482089","type":"LOCAL"},{"code":"1100785","type":"LOCAL"}],"standard_charges":[{"gross_charge":10005.0,"discounted_cash":3501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482089 = Hospital System Supply Identifier | 1100785 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005400 0 SIZE 4","code_information":[{"code":"Sx00-4500-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482091","type":"LOCAL"},{"code":"1100790","type":"LOCAL"}],"standard_charges":[{"gross_charge":10005.0,"discounted_cash":3501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482091 = Hospital System Supply Identifier | 1100790 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005404 4 SIZE 4","code_information":[{"code":"Sx00-4500-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482096","type":"LOCAL"},{"code":"1100811","type":"LOCAL"}],"standard_charges":[{"gross_charge":10005.0,"discounted_cash":3501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482096 = Hospital System Supply Identifier | 1100811 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005500 0 SIZE 5","code_information":[{"code":"Sx00-4500-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482074","type":"LOCAL"},{"code":"1100779","type":"LOCAL"}],"standard_charges":[{"gross_charge":10005.0,"discounted_cash":3501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482074 = Hospital System Supply Identifier | 1100779 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005502 2 SIZE 5","code_information":[{"code":"Sx00-4500-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482057","type":"LOCAL"},{"code":"1100781","type":"LOCAL"}],"standard_charges":[{"gross_charge":10005.0,"discounted_cash":3501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482057 = Hospital System Supply Identifier | 1100781 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005504 4 SIZE 5","code_information":[{"code":"Sx00-4500-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482075","type":"LOCAL"},{"code":"1100787","type":"LOCAL"}],"standard_charges":[{"gross_charge":10005.0,"discounted_cash":3501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482075 = Hospital System Supply Identifier | 1100787 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005604 4 SIZE 6","code_information":[{"code":"Sx00-4500-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482058","type":"LOCAL"},{"code":"1100783","type":"LOCAL"}],"standard_charges":[{"gross_charge":10005.0,"discounted_cash":3501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482058 = Hospital System Supply Identifier | 1100783 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005600 0 SIZE 6","code_information":[{"code":"Sx00-4500-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482065","type":"LOCAL"},{"code":"1100788","type":"LOCAL"}],"standard_charges":[{"gross_charge":10005.0,"discounted_cash":3501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482065 = Hospital System Supply Identifier | 1100788 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005602 2 SIZE 6","code_information":[{"code":"Sx00-4500-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482090","type":"LOCAL"},{"code":"1100799","type":"LOCAL"}],"standard_charges":[{"gross_charge":10005.0,"discounted_cash":3501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1482090 = Hospital System Supply Identifier | 1100799 = Lawson ID"}]},{"description":"K-WIRE FIX TEMP 1.6MM","code_information":[{"code":"Sx00-4501-040","type":"CDM"},{"code":"272","type":"RC"},{"code":"499631","type":"LOCAL"},{"code":"607569","type":"LOCAL"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":96.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 499631 = Hospital System Supply Identifier | 607569 = Lawson ID"}]},{"description":"PIN FIX EXTR TRAB MTL ANK 200X","code_information":[{"code":"Sx00-4501-040","type":"CDM"},{"code":"272","type":"RC"},{"code":"499633","type":"LOCAL"},{"code":"607571","type":"LOCAL"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 499633 = Hospital System Supply Identifier | 607571 = Lawson ID"}]},{"description":"BIT DRILL ZPS QC 1.1X60MM","code_information":[{"code":"Sx00-4806-060","type":"CDM"},{"code":"272","type":"RC"},{"code":"450399","type":"LOCAL"},{"code":"345074","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.05,"discounted_cash":91.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 450399 = Hospital System Supply Identifier | 345074 = Lawson ID"}]},{"description":"BIT DRILL ZPS QC 1.5X85MM","code_information":[{"code":"Sx00-4806-085","type":"CDM"},{"code":"272","type":"RC"},{"code":"450400","type":"LOCAL"},{"code":"345075","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.05,"discounted_cash":91.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 450400 = Hospital System Supply Identifier | 345075 = Lawson ID"}]},{"description":"BIT DRILL Q-C 2.0MM","code_information":[{"code":"Sx00-4806-100","type":"CDM"},{"code":"272","type":"RC"},{"code":"17826","type":"LOCAL"},{"code":"157437","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.1,"discounted_cash":89.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 17826 = Hospital System Supply Identifier | 157437 = Lawson ID"}]},{"description":"BIT DRILL Q-C 2.7MM","code_information":[{"code":"Sx00-4806-100","type":"CDM"},{"code":"272","type":"RC"},{"code":"81985","type":"LOCAL"},{"code":"157438","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.1,"discounted_cash":89.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 81985 = Hospital System Supply Identifier | 157438 = Lawson ID"}]},{"description":"BIT DRILL Q-C 2.5MM","code_information":[{"code":"Sx00-4806-110","type":"CDM"},{"code":"272","type":"RC"},{"code":"17827","type":"LOCAL"},{"code":"157439","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.1,"discounted_cash":89.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 17827 = Hospital System Supply Identifier | 157439 = Lawson ID"}]},{"description":"BIT DRILL Q-C 3.5X110MM","code_information":[{"code":"Sx00-4806-110","type":"CDM"},{"code":"272","type":"RC"},{"code":"17828","type":"LOCAL"},{"code":"157440","type":"LOCAL"}],"standard_charges":[{"gross_charge":492.5,"discounted_cash":172.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 17828 = Hospital System Supply Identifier | 157440 = Lawson ID"}]},{"description":"BIT DRILL 3.2MM","code_information":[{"code":"Sx00-4806-145","type":"CDM"},{"code":"272","type":"RC"},{"code":"149585","type":"LOCAL"},{"code":"237007","type":"LOCAL"}],"standard_charges":[{"gross_charge":382.5,"discounted_cash":133.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 149585 = Hospital System Supply Identifier | 237007 = Lawson ID"}]},{"description":"BIT DRILL 4.5X145MM QC VERSA","code_information":[{"code":"Sx00-4806-145","type":"CDM"},{"code":"272","type":"RC"},{"code":"450394","type":"LOCAL"},{"code":"317331","type":"LOCAL"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":148.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 450394 = Hospital System Supply Identifier | 317331 = Lawson ID"}]},{"description":"BIT DRILL Q/C 3.2X195MM","code_information":[{"code":"Sx00-4806-195","type":"CDM"},{"code":"272","type":"RC"},{"code":"153609","type":"LOCAL"},{"code":"294693","type":"LOCAL"}],"standard_charges":[{"gross_charge":382.5,"discounted_cash":133.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 153609 = Hospital System Supply Identifier | 294693 = Lawson ID"}]},{"description":"BIT DRILL QC NS REUSE 3.5X195","code_information":[{"code":"Sx00-4806-195","type":"CDM"},{"code":"272","type":"RC"},{"code":"196719","type":"LOCAL"},{"code":"417234","type":"LOCAL"}],"standard_charges":[{"gross_charge":492.5,"discounted_cash":172.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 196719 = Hospital System Supply Identifier | 417234 = Lawson ID"}]},{"description":"BIT DRILL Q-C 3-FLUT","code_information":[{"code":"Sx00-4807-180","type":"CDM"},{"code":"272","type":"RC"},{"code":"191884","type":"LOCAL"},{"code":"157441","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.1,"discounted_cash":89.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 191884 = Hospital System Supply Identifier | 157441 = Lawson ID"}]},{"description":"TAP SURG BONE Q/C 2.7MM SCRW","code_information":[{"code":"Sx00-4811-100","type":"CDM"},{"code":"272","type":"RC"},{"code":"17830","type":"LOCAL"},{"code":"157446","type":"LOCAL"}],"standard_charges":[{"gross_charge":272.15,"discounted_cash":95.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 17830 = Hospital System Supply Identifier | 157446 = Lawson ID"}]},{"description":"TAP SURG BONE Q/C 3.5MM SCRW","code_information":[{"code":"Sx00-4811-110","type":"CDM"},{"code":"272","type":"RC"},{"code":"191886","type":"LOCAL"},{"code":"157447","type":"LOCAL"}],"standard_charges":[{"gross_charge":272.15,"discounted_cash":95.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 191886 = Hospital System Supply Identifier | 157447 = Lawson ID"}]},{"description":"BIT SCREWDRIVER","code_information":[{"code":"Sx00-4812-045","type":"CDM"},{"code":"272","type":"RC"},{"code":"149580","type":"LOCAL"},{"code":"236996","type":"LOCAL"}],"standard_charges":[{"gross_charge":421.6,"discounted_cash":147.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 149580 = Hospital System Supply Identifier | 236996 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X6MM","code_information":[{"code":"Sx00-4815-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408965","type":"LOCAL"},{"code":"345079","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408965 = Hospital System Supply Identifier | 345079 = Lawson ID"}]},{"description":"SCREW CORT 1.5X6MM","code_information":[{"code":"Sx00-4815-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409410","type":"LOCAL"},{"code":"398070","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409410 = Hospital System Supply Identifier | 398070 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X6MM","code_information":[{"code":"Sx00-4815-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409890","type":"LOCAL"},{"code":"407448","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409890 = Hospital System Supply Identifier | 407448 = Lawson ID"}]},{"description":"SCREW CORT 1.5X7MM","code_information":[{"code":"Sx00-4815-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409411","type":"LOCAL"},{"code":"398071","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409411 = Hospital System Supply Identifier | 398071 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X7MM","code_information":[{"code":"Sx00-4815-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408966","type":"LOCAL"},{"code":"345080","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408966 = Hospital System Supply Identifier | 345080 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X7MM","code_information":[{"code":"Sx00-4815-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409891","type":"LOCAL"},{"code":"407449","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409891 = Hospital System Supply Identifier | 407449 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X8MM","code_information":[{"code":"Sx00-4815-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409892","type":"LOCAL"},{"code":"407450","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409892 = Hospital System Supply Identifier | 407450 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X8MM","code_information":[{"code":"Sx00-4815-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408967","type":"LOCAL"},{"code":"345081","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408967 = Hospital System Supply Identifier | 345081 = Lawson ID"}]},{"description":"SCREW CORT 1.5X8MM","code_information":[{"code":"Sx00-4815-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409412","type":"LOCAL"},{"code":"398072","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409412 = Hospital System Supply Identifier | 398072 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X9MM","code_information":[{"code":"Sx00-4815-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409893","type":"LOCAL"},{"code":"407451","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409893 = Hospital System Supply Identifier | 407451 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X9MM","code_information":[{"code":"Sx00-4815-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408637","type":"LOCAL"},{"code":"339148","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408637 = Hospital System Supply Identifier | 339148 = Lawson ID"}]},{"description":"SCREW CORT 1.5X9MM","code_information":[{"code":"Sx00-4815-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409413","type":"LOCAL"},{"code":"398073","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409413 = Hospital System Supply Identifier | 398073 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X10MM","code_information":[{"code":"Sx00-4815-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408638","type":"LOCAL"},{"code":"339149","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408638 = Hospital System Supply Identifier | 339149 = Lawson ID"}]},{"description":"DISC - SCREW CORT 1.5X10MM","code_information":[{"code":"Sx00-4815-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409414","type":"LOCAL"},{"code":"398074","type":"LOCAL"}],"standard_charges":[{"gross_charge":95.95,"discounted_cash":33.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409414 = Hospital System Supply Identifier | 398074 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X10M","code_information":[{"code":"Sx00-4815-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"174739","type":"LOCAL"},{"code":"407452","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 174739 = Hospital System Supply Identifier | 407452 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X11MM","code_information":[{"code":"Sx00-4815-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408639","type":"LOCAL"},{"code":"339150","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408639 = Hospital System Supply Identifier | 339150 = Lawson ID"}]},{"description":"SCREW CORT 1.5X11MM","code_information":[{"code":"Sx00-4815-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409415","type":"LOCAL"},{"code":"398075","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409415 = Hospital System Supply Identifier | 398075 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X11M","code_information":[{"code":"Sx00-4815-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409894","type":"LOCAL"},{"code":"407453","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409894 = Hospital System Supply Identifier | 407453 = Lawson ID"}]},{"description":"SCREW CORT 1.5X12MM","code_information":[{"code":"Sx00-4815-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409416","type":"LOCAL"},{"code":"398076","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409416 = Hospital System Supply Identifier | 398076 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X12MM","code_information":[{"code":"Sx00-4815-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408968","type":"LOCAL"},{"code":"345082","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408968 = Hospital System Supply Identifier | 345082 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X12M","code_information":[{"code":"Sx00-4815-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409895","type":"LOCAL"},{"code":"407454","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409895 = Hospital System Supply Identifier | 407454 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X14MM","code_information":[{"code":"Sx00-4815-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408969","type":"LOCAL"},{"code":"345083","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408969 = Hospital System Supply Identifier | 345083 = Lawson ID"}]},{"description":"SCREW CORT 1.5X14MM","code_information":[{"code":"Sx00-4815-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409417","type":"LOCAL"},{"code":"398077","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409417 = Hospital System Supply Identifier | 398077 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X14M","code_information":[{"code":"Sx00-4815-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409896","type":"LOCAL"},{"code":"407455","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409896 = Hospital System Supply Identifier | 407455 = Lawson ID"}]},{"description":"SCREW CORT 1.5X16MM","code_information":[{"code":"Sx00-4815-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409418","type":"LOCAL"},{"code":"398078","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409418 = Hospital System Supply Identifier | 398078 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X16M","code_information":[{"code":"Sx00-4815-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409897","type":"LOCAL"},{"code":"407456","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409897 = Hospital System Supply Identifier | 407456 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X16MM","code_information":[{"code":"Sx00-4815-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408640","type":"LOCAL"},{"code":"339151","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408640 = Hospital System Supply Identifier | 339151 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X18MM","code_information":[{"code":"Sx00-4815-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408898","type":"LOCAL"},{"code":"342351","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408898 = Hospital System Supply Identifier | 342351 = Lawson ID"}]},{"description":"SCREW CORT MINI 1.5X18MM","code_information":[{"code":"Sx00-4815-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409898","type":"LOCAL"},{"code":"407457","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409898 = Hospital System Supply Identifier | 407457 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X18MM","code_information":[{"code":"Sx00-4815-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408641","type":"LOCAL"},{"code":"339152","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408641 = Hospital System Supply Identifier | 339152 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X20MM","code_information":[{"code":"Sx00-4815-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408642","type":"LOCAL"},{"code":"339153","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408642 = Hospital System Supply Identifier | 339153 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X20MM","code_information":[{"code":"Sx00-4815-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408899","type":"LOCAL"},{"code":"342352","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408899 = Hospital System Supply Identifier | 342352 = Lawson ID"}]},{"description":"SCREW CORT MINI 1.5X20MM","code_information":[{"code":"Sx00-4815-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"174740","type":"LOCAL"},{"code":"407458","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 174740 = Hospital System Supply Identifier | 407458 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X22MM","code_information":[{"code":"Sx00-4815-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408643","type":"LOCAL"},{"code":"339154","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408643 = Hospital System Supply Identifier | 339154 = Lawson ID"}]},{"description":"SCREW CORT MINI 1.5X22MM","code_information":[{"code":"Sx00-4815-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409899","type":"LOCAL"},{"code":"407459","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409899 = Hospital System Supply Identifier | 407459 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X22M","code_information":[{"code":"Sx00-4815-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409900","type":"LOCAL"},{"code":"407460","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409900 = Hospital System Supply Identifier | 407460 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X24MM","code_information":[{"code":"Sx00-4815-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408644","type":"LOCAL"},{"code":"339155","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408644 = Hospital System Supply Identifier | 339155 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X24MM","code_information":[{"code":"Sx00-4815-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408900","type":"LOCAL"},{"code":"342353","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408900 = Hospital System Supply Identifier | 342353 = Lawson ID"}]},{"description":"SCREW CORT MINI 1.5X24MM","code_information":[{"code":"Sx00-4815-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409901","type":"LOCAL"},{"code":"407461","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.07,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409901 = Hospital System Supply Identifier | 407461 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 2.0X16MM","code_information":[{"code":"Sx00-4820-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409906","type":"LOCAL"},{"code":"407468","type":"LOCAL"}],"standard_charges":[{"gross_charge":103.02,"discounted_cash":36.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409906 = Hospital System Supply Identifier | 407468 = Lawson ID"}]},{"description":"BIT DRILL 2.5MM","code_information":[{"code":"Sx00-4836-205","type":"CDM"},{"code":"272","type":"RC"},{"code":"193562","type":"LOCAL"},{"code":"314279","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.1,"discounted_cash":89.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193562 = Hospital System Supply Identifier | 314279 = Lawson ID"}]},{"description":"IMP HIP BTRES AUG STR SZ54","code_information":[{"code":"Sx00-4894-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321679","type":"LOCAL"},{"code":"534893","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 321679 = Hospital System Supply Identifier | 534893 = Lawson ID"}]},{"description":"IMP ACET AUG SHIM 10D","code_information":[{"code":"Sx00-4894-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321678","type":"LOCAL"},{"code":"534892","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 321678 = Hospital System Supply Identifier | 534892 = Lawson ID"}]},{"description":"IMP HIP BTRES AUG STR SZ58","code_information":[{"code":"Sx00-4894-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321680","type":"LOCAL"},{"code":"534894","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 321680 = Hospital System Supply Identifier | 534894 = Lawson ID"}]},{"description":"IMP ACET AUG SHIM 5DEG","code_information":[{"code":"Sx00-4894-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"316780","type":"LOCAL"},{"code":"324048","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 316780 = Hospital System Supply Identifier | 324048 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 15X50MM","code_information":[{"code":"Sx00-4894-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202215","type":"LOCAL"},{"code":"452313","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202215 = Hospital System Supply Identifier | 452313 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 50X30MM","code_information":[{"code":"Sx00-4894-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327989","type":"LOCAL"},{"code":"433896","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 327989 = Hospital System Supply Identifier | 433896 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 15X50MM","code_information":[{"code":"Sx00-4894-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196706","type":"LOCAL"},{"code":"416867","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 196706 = Hospital System Supply Identifier | 416867 = Lawson ID"}]},{"description":"IMP ACET AUG ACET SZ50 20MM","code_information":[{"code":"Sx00-4894-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194102","type":"LOCAL"},{"code":"329786","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194102 = Hospital System Supply Identifier | 329786 = Lawson ID"}]},{"description":"IMP ACET AUG ACET SZ50 10MM","code_information":[{"code":"Sx00-4894-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326255","type":"LOCAL"},{"code":"393661","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326255 = Hospital System Supply Identifier | 393661 = Lawson ID"}]},{"description":"IMP HIP REV ACET 54MM","code_information":[{"code":"Sx00-4894-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326953","type":"LOCAL"},{"code":"408142","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326953 = Hospital System Supply Identifier | 408142 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 15X54MM","code_information":[{"code":"Sx00-4894-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196707","type":"LOCAL"},{"code":"416868","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 196707 = Hospital System Supply Identifier | 416868 = Lawson ID"}]},{"description":"IMP HIP ACET AUG TM SZ54 20MM","code_information":[{"code":"Sx00-4894-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202208","type":"LOCAL"},{"code":"452305","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202208 = Hospital System Supply Identifier | 452305 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ54 30","code_information":[{"code":"Sx00-4894-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321681","type":"LOCAL"},{"code":"534895","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 321681 = Hospital System Supply Identifier | 534895 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 10X58MM","code_information":[{"code":"Sx00-4894-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327301","type":"LOCAL"},{"code":"416869","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 327301 = Hospital System Supply Identifier | 416869 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 15X58MM","code_information":[{"code":"Sx00-4894-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327865","type":"LOCAL"},{"code":"428862","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 327865 = Hospital System Supply Identifier | 428862 = Lawson ID"}]},{"description":"IMP HIP ACET AUG TM SZ58 20MM","code_information":[{"code":"Sx00-4894-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202209","type":"LOCAL"},{"code":"452306","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202209 = Hospital System Supply Identifier | 452306 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ58 30","code_information":[{"code":"Sx00-4894-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321682","type":"LOCAL"},{"code":"534896","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 321682 = Hospital System Supply Identifier | 534896 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 10X62MM","code_information":[{"code":"Sx00-4894-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327302","type":"LOCAL"},{"code":"416870","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 327302 = Hospital System Supply Identifier | 416870 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 20X66MM","code_information":[{"code":"Sx00-4894-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327303","type":"LOCAL"},{"code":"416871","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 327303 = Hospital System Supply Identifier | 416871 = Lawson ID"}]},{"description":"IMP HIP ACET AUG TM SZ62 15MM","code_information":[{"code":"Sx00-4894-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202210","type":"LOCAL"},{"code":"452307","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202210 = Hospital System Supply Identifier | 452307 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ62 30","code_information":[{"code":"Sx00-4894-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321683","type":"LOCAL"},{"code":"534897","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 321683 = Hospital System Supply Identifier | 534897 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ66 20","code_information":[{"code":"Sx00-4894-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321684","type":"LOCAL"},{"code":"534898","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 321684 = Hospital System Supply Identifier | 534898 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ66 30","code_information":[{"code":"Sx00-4894-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321685","type":"LOCAL"},{"code":"534899","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 321685 = Hospital System Supply Identifier | 534899 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 10X66MM","code_information":[{"code":"Sx00-4894-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327304","type":"LOCAL"},{"code":"416872","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 327304 = Hospital System Supply Identifier | 416872 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 15X66MM","code_information":[{"code":"Sx00-4894-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327305","type":"LOCAL"},{"code":"416873","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 327305 = Hospital System Supply Identifier | 416873 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ70 10","code_information":[{"code":"Sx00-4894-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321686","type":"LOCAL"},{"code":"534900","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 321686 = Hospital System Supply Identifier | 534900 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ70 15","code_information":[{"code":"Sx00-4894-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321687","type":"LOCAL"},{"code":"534901","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 321687 = Hospital System Supply Identifier | 534901 = Lawson ID"}]},{"description":"IMP HIP BTRES AUG LT POST RT","code_information":[{"code":"Sx00-4894-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321688","type":"LOCAL"},{"code":"534902","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 321688 = Hospital System Supply Identifier | 534902 = Lawson ID"}]},{"description":"BUTTRESS COLUMN REV RT POST LT","code_information":[{"code":"Sx00-4894-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196976","type":"LOCAL"},{"code":"432039","type":"LOCAL"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 196976 = Hospital System Supply Identifier | 432039 = Lawson ID"}]},{"description":"PLATE MINI FRAG CNDYL 37 7H LT","code_information":[{"code":"Sx00-4915-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410202","type":"LOCAL"},{"code":"410451","type":"LOCAL"}],"standard_charges":[{"gross_charge":1262.84,"discounted_cash":441.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 410202 = Hospital System Supply Identifier | 410451 = Lawson ID"}]},{"description":"PLATE MINI FRAG CNDYL 37 7H RT","code_information":[{"code":"Sx00-4915-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410203","type":"LOCAL"},{"code":"410452","type":"LOCAL"}],"standard_charges":[{"gross_charge":1262.84,"discounted_cash":441.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 410203 = Hospital System Supply Identifier | 410452 = Lawson ID"}]},{"description":"PLATE MINI FRAG STR 1.5 20H","code_information":[{"code":"Sx00-4915-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408889","type":"LOCAL"},{"code":"342129","type":"LOCAL"}],"standard_charges":[{"gross_charge":1262.84,"discounted_cash":441.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408889 = Hospital System Supply Identifier | 342129 = Lawson ID"}]},{"description":"PLATE MINI FRAG CNDYL 2.0 LT","code_information":[{"code":"Sx00-4920-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408855","type":"LOCAL"},{"code":"340009","type":"LOCAL"}],"standard_charges":[{"gross_charge":1262.84,"discounted_cash":441.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408855 = Hospital System Supply Identifier | 340009 = Lawson ID"}]},{"description":"PLATE MINI FRAG L OBLQ 2.0 RT","code_information":[{"code":"Sx00-4920-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408859","type":"LOCAL"},{"code":"340013","type":"LOCAL"}],"standard_charges":[{"gross_charge":443.25,"discounted_cash":155.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408859 = Hospital System Supply Identifier | 340013 = Lawson ID"}]},{"description":"PLATE MINI FRAG L OBLQ 2.0 LT","code_information":[{"code":"Sx00-4920-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408858","type":"LOCAL"},{"code":"340012","type":"LOCAL"}],"standard_charges":[{"gross_charge":443.25,"discounted_cash":155.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408858 = Hospital System Supply Identifier | 340012 = Lawson ID"}]},{"description":"PLATE MINI FRAG CNDYL 2.0 RT","code_information":[{"code":"Sx00-4920-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408860","type":"LOCAL"},{"code":"340014","type":"LOCAL"}],"standard_charges":[{"gross_charge":1262.84,"discounted_cash":441.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408860 = Hospital System Supply Identifier | 340014 = Lawson ID"}]},{"description":"PLATE MINI FRAG L 2.0 18MM LT","code_information":[{"code":"Sx00-4920-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408856","type":"LOCAL"},{"code":"340010","type":"LOCAL"}],"standard_charges":[{"gross_charge":443.25,"discounted_cash":155.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408856 = Hospital System Supply Identifier | 340010 = Lawson ID"}]},{"description":"PLATE MINI FRAG L 2.0 18MM RT","code_information":[{"code":"Sx00-4920-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408857","type":"LOCAL"},{"code":"340011","type":"LOCAL"}],"standard_charges":[{"gross_charge":443.25,"discounted_cash":155.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408857 = Hospital System Supply Identifier | 340011 = Lawson ID"}]},{"description":"PLATE MINI FRAG T 2.0 18MM","code_information":[{"code":"Sx00-4920-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409007","type":"LOCAL"},{"code":"345121","type":"LOCAL"}],"standard_charges":[{"gross_charge":443.25,"discounted_cash":155.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409007 = Hospital System Supply Identifier | 345121 = Lawson ID"}]},{"description":"PLATE MINI FRAG STR 2.0 3H 17M","code_information":[{"code":"Sx00-4920-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409008","type":"LOCAL"},{"code":"345122","type":"LOCAL"}],"standard_charges":[{"gross_charge":689.5,"discounted_cash":241.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409008 = Hospital System Supply Identifier | 345122 = Lawson ID"}]},{"description":"PLATE MINI FRAG STR 4.0 3H 23M","code_information":[{"code":"Sx00-4920-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408674","type":"LOCAL"},{"code":"339190","type":"LOCAL"}],"standard_charges":[{"gross_charge":738.75,"discounted_cash":258.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408674 = Hospital System Supply Identifier | 339190 = Lawson ID"}]},{"description":"PLATE MINI FRAG H 2.0 4H 12MM","code_information":[{"code":"Sx00-4920-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408890","type":"LOCAL"},{"code":"342130","type":"LOCAL"}],"standard_charges":[{"gross_charge":1053.16,"discounted_cash":368.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408890 = Hospital System Supply Identifier | 342130 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 4H","code_information":[{"code":"Sx00-4920-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408673","type":"LOCAL"},{"code":"339189","type":"LOCAL"}],"standard_charges":[{"gross_charge":1435.5,"discounted_cash":502.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408673 = Hospital System Supply Identifier | 339189 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 5H","code_information":[{"code":"Sx00-4920-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408675","type":"LOCAL"},{"code":"339191","type":"LOCAL"}],"standard_charges":[{"gross_charge":1435.5,"discounted_cash":502.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408675 = Hospital System Supply Identifier | 339191 = Lawson ID"}]},{"description":"PLATE MINI FRAG STR 2.0 5H 29M","code_information":[{"code":"Sx00-4920-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409009","type":"LOCAL"},{"code":"345123","type":"LOCAL"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409009 = Hospital System Supply Identifier | 345123 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 6H","code_information":[{"code":"Sx00-4920-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408676","type":"LOCAL"},{"code":"339192","type":"LOCAL"}],"standard_charges":[{"gross_charge":1435.5,"discounted_cash":502.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408676 = Hospital System Supply Identifier | 339192 = Lawson ID"}]},{"description":"PLATE MINI FRAG STR 2.0 6H 35M","code_information":[{"code":"Sx00-4920-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409010","type":"LOCAL"},{"code":"345124","type":"LOCAL"}],"standard_charges":[{"gross_charge":837.25,"discounted_cash":293.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409010 = Hospital System Supply Identifier | 345124 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 7H","code_information":[{"code":"Sx00-4920-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408677","type":"LOCAL"},{"code":"339193","type":"LOCAL"}],"standard_charges":[{"gross_charge":1435.5,"discounted_cash":502.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408677 = Hospital System Supply Identifier | 339193 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 8H","code_information":[{"code":"Sx00-4920-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408861","type":"LOCAL"},{"code":"340015","type":"LOCAL"}],"standard_charges":[{"gross_charge":1435.5,"discounted_cash":502.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408861 = Hospital System Supply Identifier | 340015 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 10H","code_information":[{"code":"Sx00-4920-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408862","type":"LOCAL"},{"code":"340016","type":"LOCAL"}],"standard_charges":[{"gross_charge":1435.5,"discounted_cash":502.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408862 = Hospital System Supply Identifier | 340016 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 12H","code_information":[{"code":"Sx00-4920-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408863","type":"LOCAL"},{"code":"340017","type":"LOCAL"}],"standard_charges":[{"gross_charge":1435.5,"discounted_cash":502.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408863 = Hospital System Supply Identifier | 340017 = Lawson ID"}]},{"description":"PLATE MINI FRAG STR 20H 100MM","code_information":[{"code":"Sx00-4920-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408864","type":"LOCAL"},{"code":"340018","type":"LOCAL"}],"standard_charges":[{"gross_charge":1262.84,"discounted_cash":441.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408864 = Hospital System Supply Identifier | 340018 = Lawson ID"}]},{"description":"PLATE MINI FRAG T 2.0 3H HD 9H","code_information":[{"code":"Sx00-4920-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408865","type":"LOCAL"},{"code":"340019","type":"LOCAL"}],"standard_charges":[{"gross_charge":1053.16,"discounted_cash":368.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408865 = Hospital System Supply Identifier | 340019 = Lawson ID"}]},{"description":"PLATE MINI FRAG T 2.0 4H HD 9H","code_information":[{"code":"Sx00-4920-049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408866","type":"LOCAL"},{"code":"340020","type":"LOCAL"}],"standard_charges":[{"gross_charge":1053.16,"discounted_cash":368.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408866 = Hospital System Supply Identifier | 340020 = Lawson ID"}]},{"description":"PLATE BONE 4 HOLE CONDYLAR LEFT 00492700119 STAINLESS STEEL 2..7X57MM","code_information":[{"code":"Sx00-4927-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1262964","type":"LOCAL"},{"code":"1062919","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.6,"discounted_cash":459.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1262964 = Hospital System Supply Identifier | 1062919 = Lawson ID"}]},{"description":"PLATE BONE 4 HOLE CONDYLAR RIGHT 00492700219 STAINLESS STEEL 2.7X57MM","code_information":[{"code":"Sx00-4927-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1262965","type":"LOCAL"},{"code":"1062862","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.6,"discounted_cash":459.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1262965 = Hospital System Supply Identifier | 1062862 = Lawson ID"}]},{"description":"PLATE MINI FRAG 1/4 TBLR 3H","code_information":[{"code":"Sx00-4927-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409011","type":"LOCAL"},{"code":"345125","type":"LOCAL"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409011 = Hospital System Supply Identifier | 345125 = Lawson ID"}]},{"description":"PLATE MINI FRAG 1/4 TBLR 4H","code_information":[{"code":"Sx00-4927-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409012","type":"LOCAL"},{"code":"345126","type":"LOCAL"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409012 = Hospital System Supply Identifier | 345126 = Lawson ID"}]},{"description":"PLATE MINI FRAG 1/4 TBLR 5H","code_information":[{"code":"Sx00-4927-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409013","type":"LOCAL"},{"code":"345127","type":"LOCAL"}],"standard_charges":[{"gross_charge":886.5,"discounted_cash":310.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409013 = Hospital System Supply Identifier | 345127 = Lawson ID"}]},{"description":"PLATE MINI FRAG 1/4 TBLR 6H","code_information":[{"code":"Sx00-4927-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408564","type":"LOCAL"},{"code":"332731","type":"LOCAL"}],"standard_charges":[{"gross_charge":985.0,"discounted_cash":344.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 408564 = Hospital System Supply Identifier | 332731 = Lawson ID"}]},{"description":"PLATE MINI FRAG 1/4 TBLR 7H","code_information":[{"code":"Sx00-4927-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409014","type":"LOCAL"},{"code":"345128","type":"LOCAL"}],"standard_charges":[{"gross_charge":985.0,"discounted_cash":344.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409014 = Hospital System Supply Identifier | 345128 = Lawson ID"}]},{"description":"PLATE MINI FRAG 1/4 TBLR 8H","code_information":[{"code":"Sx00-4927-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409015","type":"LOCAL"},{"code":"345129","type":"LOCAL"}],"standard_charges":[{"gross_charge":985.0,"discounted_cash":344.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409015 = Hospital System Supply Identifier | 345129 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 38MM","code_information":[{"code":"Sx00-5001-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303178","type":"LOCAL"},{"code":"522124","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303178 = Hospital System Supply Identifier | 522124 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 38X22MM","code_information":[{"code":"Sx00-5001-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303179","type":"LOCAL"},{"code":"522125","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303179 = Hospital System Supply Identifier | 522125 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 39MM","code_information":[{"code":"Sx00-5001-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303180","type":"LOCAL"},{"code":"522126","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303180 = Hospital System Supply Identifier | 522126 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 39X22MM","code_information":[{"code":"Sx00-5001-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303181","type":"LOCAL"},{"code":"522127","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303181 = Hospital System Supply Identifier | 522127 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 40X26MM","code_information":[{"code":"Sx00-5001-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303182","type":"LOCAL"},{"code":"522128","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303182 = Hospital System Supply Identifier | 522128 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-40-22","code_information":[{"code":"Sx00-5001-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168554","type":"LOCAL"},{"code":"208831","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 168554 = Hospital System Supply Identifier | 208831 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-40","code_information":[{"code":"Sx00-5001-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168544","type":"LOCAL"},{"code":"208810","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 168544 = Hospital System Supply Identifier | 208810 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-41","code_information":[{"code":"Sx00-5001-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168545","type":"LOCAL"},{"code":"208811","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 168545 = Hospital System Supply Identifier | 208811 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-42","code_information":[{"code":"Sx00-5001-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168546","type":"LOCAL"},{"code":"208812","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 168546 = Hospital System Supply Identifier | 208812 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-42-22","code_information":[{"code":"Sx00-5001-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145660","type":"LOCAL"},{"code":"208832","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145660 = Hospital System Supply Identifier | 208832 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 42X26MM","code_information":[{"code":"Sx00-5001-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303183","type":"LOCAL"},{"code":"522129","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303183 = Hospital System Supply Identifier | 522129 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-43","code_information":[{"code":"Sx00-5001-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145652","type":"LOCAL"},{"code":"208813","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145652 = Hospital System Supply Identifier | 208813 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 44X26MM","code_information":[{"code":"Sx00-5001-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303185","type":"LOCAL"},{"code":"522131","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303185 = Hospital System Supply Identifier | 522131 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-44-28","code_information":[{"code":"Sx00-5001-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145661","type":"LOCAL"},{"code":"208833","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145661 = Hospital System Supply Identifier | 208833 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-44","code_information":[{"code":"Sx00-5001-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145653","type":"LOCAL"},{"code":"208814","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145653 = Hospital System Supply Identifier | 208814 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 44X22MM","code_information":[{"code":"Sx00-5001-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303184","type":"LOCAL"},{"code":"522130","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303184 = Hospital System Supply Identifier | 522130 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-45","code_information":[{"code":"Sx00-5001-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145654","type":"LOCAL"},{"code":"208815","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145654 = Hospital System Supply Identifier | 208815 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-46","code_information":[{"code":"Sx00-5001-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145655","type":"LOCAL"},{"code":"208816","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145655 = Hospital System Supply Identifier | 208816 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-47","code_information":[{"code":"Sx00-5001-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145656","type":"LOCAL"},{"code":"208817","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145656 = Hospital System Supply Identifier | 208817 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-47-28","code_information":[{"code":"Sx00-5001-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145662","type":"LOCAL"},{"code":"208834","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145662 = Hospital System Supply Identifier | 208834 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 47X22MM","code_information":[{"code":"Sx00-5001-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303186","type":"LOCAL"},{"code":"522132","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303186 = Hospital System Supply Identifier | 522132 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 47X26MM","code_information":[{"code":"Sx00-5001-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303187","type":"LOCAL"},{"code":"522133","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303187 = Hospital System Supply Identifier | 522133 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 47X32MM","code_information":[{"code":"Sx00-5001-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303188","type":"LOCAL"},{"code":"522134","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303188 = Hospital System Supply Identifier | 522134 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-48","code_information":[{"code":"Sx00-5001-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145657","type":"LOCAL"},{"code":"208818","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145657 = Hospital System Supply Identifier | 208818 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-49","code_information":[{"code":"Sx00-5001-049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168547","type":"LOCAL"},{"code":"208819","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 168547 = Hospital System Supply Identifier | 208819 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 50X32MM","code_information":[{"code":"Sx00-5001-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303191","type":"LOCAL"},{"code":"522137","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303191 = Hospital System Supply Identifier | 522137 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 50X26MM","code_information":[{"code":"Sx00-5001-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303190","type":"LOCAL"},{"code":"522136","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303190 = Hospital System Supply Identifier | 522136 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 50X22MM","code_information":[{"code":"Sx00-5001-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303189","type":"LOCAL"},{"code":"522135","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303189 = Hospital System Supply Identifier | 522135 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-50-28","code_information":[{"code":"Sx00-5001-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145663","type":"LOCAL"},{"code":"208835","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145663 = Hospital System Supply Identifier | 208835 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-50","code_information":[{"code":"Sx00-5001-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145658","type":"LOCAL"},{"code":"208820","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145658 = Hospital System Supply Identifier | 208820 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-51","code_information":[{"code":"Sx00-5001-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168548","type":"LOCAL"},{"code":"208821","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 168548 = Hospital System Supply Identifier | 208821 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-52","code_information":[{"code":"Sx00-5001-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145659","type":"LOCAL"},{"code":"208822","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145659 = Hospital System Supply Identifier | 208822 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-53","code_information":[{"code":"Sx00-5001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168549","type":"LOCAL"},{"code":"208823","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 168549 = Hospital System Supply Identifier | 208823 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-53-28","code_information":[{"code":"Sx00-5001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168555","type":"LOCAL"},{"code":"208836","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 168555 = Hospital System Supply Identifier | 208836 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 53X22MM","code_information":[{"code":"Sx00-5001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303192","type":"LOCAL"},{"code":"522138","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303192 = Hospital System Supply Identifier | 522138 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 53X26MM","code_information":[{"code":"Sx00-5001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303193","type":"LOCAL"},{"code":"522139","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303193 = Hospital System Supply Identifier | 522139 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 53X32MM","code_information":[{"code":"Sx00-5001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303194","type":"LOCAL"},{"code":"522140","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303194 = Hospital System Supply Identifier | 522140 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-54","code_information":[{"code":"Sx00-5001-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168550","type":"LOCAL"},{"code":"208824","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 168550 = Hospital System Supply Identifier | 208824 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-55","code_information":[{"code":"Sx00-5001-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168551","type":"LOCAL"},{"code":"208825","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 168551 = Hospital System Supply Identifier | 208825 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 57X26MM","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303196","type":"LOCAL"},{"code":"522142","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303196 = Hospital System Supply Identifier | 522142 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 57X22MM","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303195","type":"LOCAL"},{"code":"522141","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303195 = Hospital System Supply Identifier | 522141 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 57X32MM","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303197","type":"LOCAL"},{"code":"522143","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303197 = Hospital System Supply Identifier | 522143 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-57","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168552","type":"LOCAL"},{"code":"208826","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 168552 = Hospital System Supply Identifier | 208826 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-57-28","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168556","type":"LOCAL"},{"code":"208837","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 168556 = Hospital System Supply Identifier | 208837 = Lawson ID"}]},{"description":"IMP HIP SHELL MULTIPOLAR","code_information":[{"code":"Sx00-5001-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168553","type":"LOCAL"},{"code":"208827","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 168553 = Hospital System Supply Identifier | 208827 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 60X26MM","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303199","type":"LOCAL"},{"code":"522145","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303199 = Hospital System Supply Identifier | 522145 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 60X22MM","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303198","type":"LOCAL"},{"code":"522144","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303198 = Hospital System Supply Identifier | 522144 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 60X32MM","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303200","type":"LOCAL"},{"code":"522146","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303200 = Hospital System Supply Identifier | 522146 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-60","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178233","type":"LOCAL"},{"code":"208828","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178233 = Hospital System Supply Identifier | 208828 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-60-28","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178234","type":"LOCAL"},{"code":"208838","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178234 = Hospital System Supply Identifier | 208838 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-62","code_information":[{"code":"Sx00-5001-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323414","type":"LOCAL"},{"code":"208829","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 323414 = Hospital System Supply Identifier | 208829 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 64X32MM","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303202","type":"LOCAL"},{"code":"522148","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303202 = Hospital System Supply Identifier | 522148 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 64X26MM","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303201","type":"LOCAL"},{"code":"522147","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303201 = Hospital System Supply Identifier | 522147 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-64","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323415","type":"LOCAL"},{"code":"208830","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 323415 = Hospital System Supply Identifier | 208830 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-64-28","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329021","type":"LOCAL"},{"code":"208839","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329021 = Hospital System Supply Identifier | 208839 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 66MM","code_information":[{"code":"Sx00-5001-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303203","type":"LOCAL"},{"code":"522149","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303203 = Hospital System Supply Identifier | 522149 = Lawson ID"}]},{"description":"IMP HIP SHELL MULTPLR 68-70","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326954","type":"LOCAL"},{"code":"408143","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326954 = Hospital System Supply Identifier | 408143 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 68MM","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303204","type":"LOCAL"},{"code":"522150","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303204 = Hospital System Supply Identifier | 522150 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 68X26MM","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303205","type":"LOCAL"},{"code":"522151","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303205 = Hospital System Supply Identifier | 522151 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 68X32MM","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303206","type":"LOCAL"},{"code":"522152","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303206 = Hospital System Supply Identifier | 522152 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 70MM","code_information":[{"code":"Sx00-5001-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303207","type":"LOCAL"},{"code":"522153","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303207 = Hospital System Supply Identifier | 522153 = Lawson ID"}]},{"description":"IMP HIP SHELL MULTPLR 72","code_information":[{"code":"Sx00-5001-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326955","type":"LOCAL"},{"code":"408144","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326955 = Hospital System Supply Identifier | 408144 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 72MM","code_information":[{"code":"Sx00-5001-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303208","type":"LOCAL"},{"code":"522154","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303208 = Hospital System Supply Identifier | 522154 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 72X26MM","code_information":[{"code":"Sx00-5001-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303209","type":"LOCAL"},{"code":"522155","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303209 = Hospital System Supply Identifier | 522155 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 72X32MM","code_information":[{"code":"Sx00-5001-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303210","type":"LOCAL"},{"code":"522156","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303210 = Hospital System Supply Identifier | 522156 = Lawson ID"}]},{"description":"IMP HIP LNR PRVSNL 22 38-43MM","code_information":[{"code":"Sx00-5003-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449578","type":"LOCAL"},{"code":"310982","type":"LOCAL"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 449578 = Hospital System Supply Identifier | 310982 = Lawson ID"}]},{"description":"IMP HIP LNR PRVSNL 28 44-49MM","code_information":[{"code":"Sx00-5003-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324475","type":"LOCAL"},{"code":"310983","type":"LOCAL"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 324475 = Hospital System Supply Identifier | 310983 = Lawson ID"}]},{"description":"IMP HIP LNR PRVSNL 28 50-58MM","code_information":[{"code":"Sx00-5003-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449579","type":"LOCAL"},{"code":"310984","type":"LOCAL"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 449579 = Hospital System Supply Identifier | 310984 = Lawson ID"}]},{"description":"IMP HIP LNR PRVSNL 28 60-72MM","code_information":[{"code":"Sx00-5003-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449577","type":"LOCAL"},{"code":"310981","type":"LOCAL"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 449577 = Hospital System Supply Identifier | 310981 = Lawson ID"}]},{"description":"BLADE MICRO MILL 19 204","code_information":[{"code":"Sx00-5052-204","type":"CDM"},{"code":"272","type":"RC"},{"code":"72589","type":"LOCAL"},{"code":"100437","type":"LOCAL"}],"standard_charges":[{"gross_charge":482.4,"discounted_cash":168.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 72589 = Hospital System Supply Identifier | 100437 = Lawson ID"}]},{"description":"PIN HEX HD HLDNG","code_information":[{"code":"Sx00-5061-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"149980","type":"LOCAL"},{"code":"237595","type":"LOCAL"}],"standard_charges":[{"gross_charge":75.9,"discounted_cash":26.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 149980 = Hospital System Supply Identifier | 237595 = Lawson ID"}]},{"description":"SYSTEM BONE CEMENT NSTRL REMOV","code_information":[{"code":"Sx00-5061-084","type":"CDM"},{"code":"272","type":"RC"},{"code":"932071","type":"LOCAL"},{"code":"816445","type":"LOCAL"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 932071 = Hospital System Supply Identifier | 816445 = Lawson ID"}]},{"description":"BLADE EXTRACTOR EXODUS HIP STEM REMOVAL 0051040000","code_information":[{"code":"Sx00-510-400-","type":"CDM"},{"code":"272","type":"RC"},{"code":"1182618","type":"LOCAL"},{"code":"1008181","type":"LOCAL"}],"standard_charges":[{"gross_charge":7008.75,"discounted_cash":2453.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1182618 = Hospital System Supply Identifier | 1008181 = Lawson ID"}]},{"description":"INSERT TIBIAL KNEE FIXED LIPPED MG II 00511004313 13MM SIZE E F","code_information":[{"code":"Sx00-5110-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1555969","type":"LOCAL"},{"code":"1112266","type":"LOCAL"}],"standard_charges":[{"gross_charge":7512.75,"discounted_cash":2629.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1555969 = Hospital System Supply Identifier | 1112266 = Lawson ID"}]},{"description":"BIT DRILL PTELA/FEM","code_information":[{"code":"Sx00-5120-052","type":"CDM"},{"code":"272","type":"RC"},{"code":"158236","type":"LOCAL"},{"code":"313633","type":"LOCAL"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":134.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 158236 = Hospital System Supply Identifier | 313633 = Lawson ID"}]},{"description":"BIT DRILL 12.7MM NSTRL PEG SS TIBIA MG II","code_information":[{"code":"Sx00-5120-067","type":"CDM"},{"code":"272","type":"RC"},{"code":"1090157","type":"LOCAL"},{"code":"S516400","type":"LOCAL"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":183.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1090157 = Hospital System Supply Identifier | S516400 = Lawson ID"}]},{"description":"BIT DRILL W/CONNECT 3.2MM","code_information":[{"code":"Sx00-5120-085","type":"CDM"},{"code":"272","type":"RC"},{"code":"149984","type":"LOCAL"},{"code":"237602","type":"LOCAL"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":134.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 149984 = Hospital System Supply Identifier | 237602 = Lawson ID"}]},{"description":"SCRDRVR HEX MGII 3.5MM","code_information":[{"code":"Sx00-5120-087","type":"CDM"},{"code":"272","type":"RC"},{"code":"202340","type":"LOCAL"},{"code":"452439","type":"LOCAL"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202340 = Hospital System Supply Identifier | 452439 = Lawson ID"}]},{"description":"PLATE TIBIAL 0D NSTRL BOOM SS KNEE MG II","code_information":[{"code":"Sx00-5125-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1100365","type":"LOCAL"},{"code":"S119123","type":"LOCAL"}],"standard_charges":[{"gross_charge":2766.92,"discounted_cash":968.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1100365 = Hospital System Supply Identifier | S119123 = Lawson ID"}]},{"description":"CLMP INDEPEND LOK 2D LG XTRFX","code_information":[{"code":"Sx00-5200-090","type":"CDM"},{"code":"272","type":"RC"},{"code":"411459","type":"LOCAL"},{"code":"623375","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 411459 = Hospital System Supply Identifier | 623375 = Lawson ID"}]},{"description":"IMP ORTH BAR XTRAFIX 11X100MM","code_information":[{"code":"Sx00-5202-011","type":"CDM"},{"code":"272","type":"RC"},{"code":"410495","type":"LOCAL"},{"code":"421381","type":"LOCAL"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 410495 = Hospital System Supply Identifier | 421381 = Lawson ID"}]},{"description":"POST FIX EXT STR 11MM","code_information":[{"code":"Sx00-5202-090","type":"CDM"},{"code":"272","type":"RC"},{"code":"409363","type":"LOCAL"},{"code":"395473","type":"LOCAL"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409363 = Hospital System Supply Identifier | 395473 = Lawson ID"}]},{"description":"POST FIX EXT STR 11MM 30DEGREE","code_information":[{"code":"Sx00-5202-090","type":"CDM"},{"code":"272","type":"RC"},{"code":"411430","type":"LOCAL"},{"code":"595879","type":"LOCAL"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 411430 = Hospital System Supply Identifier | 595879 = Lawson ID"}]},{"description":"IMP FIX PIN HALF 4X100X35MM","code_information":[{"code":"Sx00-5204-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410497","type":"LOCAL"},{"code":"421384","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":124.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 410497 = Hospital System Supply Identifier | 421384 = Lawson ID"}]},{"description":"PIN FIX EXT HALF 5X200X45MM","code_information":[{"code":"Sx00-5204-050","type":"CDM"},{"code":"272","type":"RC"},{"code":"410532","type":"LOCAL"},{"code":"428125","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":124.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 410532 = Hospital System Supply Identifier | 428125 = Lawson ID"}]},{"description":"PIN FIX EXT HALF 5X200X65MM","code_information":[{"code":"Sx00-5204-050","type":"CDM"},{"code":"272","type":"RC"},{"code":"411190","type":"LOCAL"},{"code":"438994","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":124.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 411190 = Hospital System Supply Identifier | 438994 = Lawson ID"}]},{"description":"PIN FIX EXT HALF 5X160X35MM","code_information":[{"code":"Sx00-5204-050","type":"CDM"},{"code":"272","type":"RC"},{"code":"409364","type":"LOCAL"},{"code":"395474","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":124.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409364 = Hospital System Supply Identifier | 395474 = Lawson ID"}]},{"description":"PIN FIX EXT 5X160X55MM","code_information":[{"code":"Sx00-5204-050","type":"CDM"},{"code":"272","type":"RC"},{"code":"409365","type":"LOCAL"},{"code":"395475","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":124.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409365 = Hospital System Supply Identifier | 395475 = Lawson ID"}]},{"description":"PIN FIX EXT 6X200X55MM","code_information":[{"code":"Sx00-5204-060","type":"CDM"},{"code":"272","type":"RC"},{"code":"356301","type":"LOCAL"},{"code":"395476","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":124.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 356301 = Hospital System Supply Identifier | 395476 = Lawson ID"}]},{"description":"PIN FIX EXT TRNSFIXNG BLK 6MM","code_information":[{"code":"Sx00-5204-090","type":"CDM"},{"code":"272","type":"RC"},{"code":"409366","type":"LOCAL"},{"code":"395477","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":124.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409366 = Hospital System Supply Identifier | 395477 = Lawson ID"}]},{"description":"PIN 1/2 BLUNT 5X160X55MM","code_information":[{"code":"Sx00-5205-050","type":"CDM"},{"code":"272","type":"RC"},{"code":"410520","type":"LOCAL"},{"code":"425148","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":124.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 410520 = Hospital System Supply Identifier | 425148 = Lawson ID"}]},{"description":"DRILL MED 4.0MM","code_information":[{"code":"Sx00-5207-040","type":"CDM"},{"code":"272","type":"RC"},{"code":"409367","type":"LOCAL"},{"code":"395478","type":"LOCAL"}],"standard_charges":[{"gross_charge":591.0,"discounted_cash":206.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409367 = Hospital System Supply Identifier | 395478 = Lawson ID"}]},{"description":"BIT DRILL LNG 4.0MM","code_information":[{"code":"Sx00-5207-040","type":"CDM"},{"code":"272","type":"RC"},{"code":"411381","type":"LOCAL"},{"code":"463697","type":"LOCAL"}],"standard_charges":[{"gross_charge":591.0,"discounted_cash":206.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 411381 = Hospital System Supply Identifier | 463697 = Lawson ID"}]},{"description":"DRILL 4.5MM","code_information":[{"code":"Sx00-5207-045","type":"CDM"},{"code":"272","type":"RC"},{"code":"409368","type":"LOCAL"},{"code":"395479","type":"LOCAL"}],"standard_charges":[{"gross_charge":591.0,"discounted_cash":206.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 409368 = Hospital System Supply Identifier | 395479 = Lawson ID"}]},{"description":"PIN HEADLSS TIB WDG PRVSNL 48","code_information":[{"code":"Sx00-5222-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"329152","type":"LOCAL"},{"code":"258701","type":"LOCAL"}],"standard_charges":[{"gross_charge":101.65,"discounted_cash":35.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329152 = Hospital System Supply Identifier | 258701 = Lawson ID"}]},{"description":"IMP FEM COMP GSM FLX SZ1 RT","code_information":[{"code":"Sx00-5410-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"166068","type":"LOCAL"},{"code":"388017","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 166068 = Hospital System Supply Identifier | 388017 = Lawson ID"}]},{"description":"IMP KNEE GSM NP FLEX FEM SIZE","code_information":[{"code":"Sx00-5410-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"439272","type":"LOCAL"},{"code":"446467","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 439272 = Hospital System Supply Identifier | 446467 = Lawson ID"}]},{"description":"COMPONENT FEMORAL SZ 2 RT","code_information":[{"code":"Sx00-5410-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"163708","type":"LOCAL"},{"code":"366329","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 163708 = Hospital System Supply Identifier | 366329 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM NP FLX SZ2 LT","code_information":[{"code":"Sx00-5410-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328260","type":"LOCAL"},{"code":"441601","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 328260 = Hospital System Supply Identifier | 441601 = Lawson ID"}]},{"description":"COMPONENT FEMORAL SZ 3 RT","code_information":[{"code":"Sx00-5410-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325891","type":"LOCAL"},{"code":"366326","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325891 = Hospital System Supply Identifier | 366326 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM NP FLX SZ3 LT","code_information":[{"code":"Sx00-5410-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179011","type":"LOCAL"},{"code":"441602","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179011 = Hospital System Supply Identifier | 441602 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM NP FLX SZ4 RT","code_information":[{"code":"Sx00-5410-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179012","type":"LOCAL"},{"code":"441604","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179012 = Hospital System Supply Identifier | 441604 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM NP FLX SZ4 LT","code_information":[{"code":"Sx00-5410-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328261","type":"LOCAL"},{"code":"441603","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 328261 = Hospital System Supply Identifier | 441603 = Lawson ID"}]},{"description":"IMP KNEE GSM NP FLEX FEM SIZE","code_information":[{"code":"Sx00-5410-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179059","type":"LOCAL"},{"code":"446468","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179059 = Hospital System Supply Identifier | 446468 = Lawson ID"}]},{"description":"FEMUR GSM FLEX SZ 5 RT","code_information":[{"code":"Sx00-5410-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"166017","type":"LOCAL"},{"code":"386217","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 166017 = Hospital System Supply Identifier | 386217 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 1-LT","code_information":[{"code":"Sx00-5412-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303238","type":"LOCAL"},{"code":"522195","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303238 = Hospital System Supply Identifier | 522195 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 1-RT","code_information":[{"code":"Sx00-5412-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303239","type":"LOCAL"},{"code":"522196","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303239 = Hospital System Supply Identifier | 522196 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 2-LT","code_information":[{"code":"Sx00-5412-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303240","type":"LOCAL"},{"code":"522197","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303240 = Hospital System Supply Identifier | 522197 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 2-RT","code_information":[{"code":"Sx00-5412-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303241","type":"LOCAL"},{"code":"522198","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303241 = Hospital System Supply Identifier | 522198 = Lawson ID"}]},{"description":"IMP KNEE GSM POR FLEX FEM SIZE","code_information":[{"code":"Sx00-5412-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662230","type":"LOCAL"},{"code":"446469","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662230 = Hospital System Supply Identifier | 446469 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 3-RT","code_information":[{"code":"Sx00-5412-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303242","type":"LOCAL"},{"code":"522199","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303242 = Hospital System Supply Identifier | 522199 = Lawson ID"}]},{"description":"IMP KNEE GSM POR FLEX FEM SIZE","code_information":[{"code":"Sx00-5412-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662231","type":"LOCAL"},{"code":"446470","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662231 = Hospital System Supply Identifier | 446470 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 4-RT","code_information":[{"code":"Sx00-5412-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303243","type":"LOCAL"},{"code":"522200","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303243 = Hospital System Supply Identifier | 522200 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 5-LT","code_information":[{"code":"Sx00-5412-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303244","type":"LOCAL"},{"code":"522201","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303244 = Hospital System Supply Identifier | 522201 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 5-RT","code_information":[{"code":"Sx00-5412-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303245","type":"LOCAL"},{"code":"522202","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303245 = Hospital System Supply Identifier | 522202 = Lawson ID"}]},{"description":"FEMUR GFS FLEX SZ 0 LT","code_information":[{"code":"Sx00-5414-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164491","type":"LOCAL"},{"code":"370023","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 164491 = Hospital System Supply Identifier | 370023 = Lawson ID"}]},{"description":"IMP KNEE FEM 0 RT","code_information":[{"code":"Sx00-5414-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"181656","type":"LOCAL"},{"code":"453455","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 181656 = Hospital System Supply Identifier | 453455 = Lawson ID"}]},{"description":"FEMORAL COMP GSF FLEX SZ 1 LT","code_information":[{"code":"Sx00-5414-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164240","type":"LOCAL"},{"code":"369325","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 164240 = Hospital System Supply Identifier | 369325 = Lawson ID"}]},{"description":"FEMORAL COMP GSF FLEX SZ 1 RT","code_information":[{"code":"Sx00-5414-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164483","type":"LOCAL"},{"code":"370011","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 164483 = Hospital System Supply Identifier | 370011 = Lawson ID"}]},{"description":"FEMUR GFS SZ 2 RT","code_information":[{"code":"Sx00-5414-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"165253","type":"LOCAL"},{"code":"374466","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 165253 = Hospital System Supply Identifier | 374466 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF NP FLX SZ2 LT","code_information":[{"code":"Sx00-5414-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328262","type":"LOCAL"},{"code":"441605","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 328262 = Hospital System Supply Identifier | 441605 = Lawson ID"}]},{"description":"IMP GSF NP FLEX FEM SIZE 3 LEF","code_information":[{"code":"Sx00-5414-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"445181","type":"LOCAL"},{"code":"446473","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 445181 = Hospital System Supply Identifier | 446473 = Lawson ID"}]},{"description":"COMPONENT GSF FEMORAL SZ 3","code_information":[{"code":"Sx00-5414-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169985","type":"LOCAL"},{"code":"366331","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 169985 = Hospital System Supply Identifier | 366331 = Lawson ID"}]},{"description":"IMP KNEE GSF NP FLEX FEM SIZE","code_information":[{"code":"Sx00-5414-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"445182","type":"LOCAL"},{"code":"446474","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 445182 = Hospital System Supply Identifier | 446474 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF NP FLX 4-LT","code_information":[{"code":"Sx00-5414-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303246","type":"LOCAL"},{"code":"522203","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303246 = Hospital System Supply Identifier | 522203 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 0 LT","code_information":[{"code":"Sx00-5416-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306350","type":"LOCAL"},{"code":"526192","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 306350 = Hospital System Supply Identifier | 526192 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 0 RT","code_information":[{"code":"Sx00-5416-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306351","type":"LOCAL"},{"code":"526193","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 306351 = Hospital System Supply Identifier | 526193 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 1 LT","code_information":[{"code":"Sx00-5416-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306352","type":"LOCAL"},{"code":"526194","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 306352 = Hospital System Supply Identifier | 526194 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 1 RT","code_information":[{"code":"Sx00-5416-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306353","type":"LOCAL"},{"code":"526195","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 306353 = Hospital System Supply Identifier | 526195 = Lawson ID"}]},{"description":"IMP KNEE GSF POR FLEX FEM SIZE","code_information":[{"code":"Sx00-5416-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662233","type":"LOCAL"},{"code":"446475","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662233 = Hospital System Supply Identifier | 446475 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 2 LT","code_information":[{"code":"Sx00-5416-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306354","type":"LOCAL"},{"code":"526196","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 306354 = Hospital System Supply Identifier | 526196 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 2 RT","code_information":[{"code":"Sx00-5416-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306355","type":"LOCAL"},{"code":"526197","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 306355 = Hospital System Supply Identifier | 526197 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 3 LT","code_information":[{"code":"Sx00-5416-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306356","type":"LOCAL"},{"code":"526198","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 306356 = Hospital System Supply Identifier | 526198 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 3 RT","code_information":[{"code":"Sx00-5416-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306357","type":"LOCAL"},{"code":"526199","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 306357 = Hospital System Supply Identifier | 526199 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 4 LT","code_information":[{"code":"Sx00-5416-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306358","type":"LOCAL"},{"code":"526200","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 306358 = Hospital System Supply Identifier | 526200 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0LT 11","code_information":[{"code":"Sx00-5424-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303256","type":"LOCAL"},{"code":"522213","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303256 = Hospital System Supply Identifier | 522213 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0LT 19","code_information":[{"code":"Sx00-5424-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303259","type":"LOCAL"},{"code":"522216","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303259 = Hospital System Supply Identifier | 522216 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0LT 16","code_information":[{"code":"Sx00-5424-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303258","type":"LOCAL"},{"code":"522215","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303258 = Hospital System Supply Identifier | 522215 = Lawson ID"}]},{"description":"IMP FLX PROLONG ART SURF SIZE","code_information":[{"code":"Sx00-5424-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179060","type":"LOCAL"},{"code":"446479","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179060 = Hospital System Supply Identifier | 446479 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0LT 13","code_information":[{"code":"Sx00-5424-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303257","type":"LOCAL"},{"code":"522214","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303257 = Hospital System Supply Identifier | 522214 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PRO .5 LT 9","code_information":[{"code":"Sx00-5424-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179014","type":"LOCAL"},{"code":"441610","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179014 = Hospital System Supply Identifier | 441610 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PRO .5 LT 11","code_information":[{"code":"Sx00-5424-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328266","type":"LOCAL"},{"code":"441611","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 328266 = Hospital System Supply Identifier | 441611 = Lawson ID"}]},{"description":"IMP FLX PROLONG ART SURF SIZE","code_information":[{"code":"Sx00-5424-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"199186","type":"LOCAL"},{"code":"446480","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 199186 = Hospital System Supply Identifier | 446480 = Lawson ID"}]},{"description":"IMP FLX PROLONG ART SURF SIZE","code_information":[{"code":"Sx00-5424-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"439273","type":"LOCAL"},{"code":"446481","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 439273 = Hospital System Supply Identifier | 446481 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ1/2LT 19","code_information":[{"code":"Sx00-5424-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303260","type":"LOCAL"},{"code":"522217","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303260 = Hospital System Supply Identifier | 522217 = Lawson ID"}]},{"description":"IMP FLX PRLONG ART SURFACE SIZ","code_information":[{"code":"Sx00-5424-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662234","type":"LOCAL"},{"code":"446484","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662234 = Hospital System Supply Identifier | 446484 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PRO 345 LT13","code_information":[{"code":"Sx00-5424-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328267","type":"LOCAL"},{"code":"441612","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 328267 = Hospital System Supply Identifier | 441612 = Lawson ID"}]},{"description":"IMP FLX PRLONG ART SURFACE SZE","code_information":[{"code":"Sx00-5424-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179061","type":"LOCAL"},{"code":"446482","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179061 = Hospital System Supply Identifier | 446482 = Lawson ID"}]},{"description":"IMP FLX PRLONG ART SURF SIZE 3","code_information":[{"code":"Sx00-5424-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179062","type":"LOCAL"},{"code":"446483","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179062 = Hospital System Supply Identifier | 446483 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC S3/4/5LT 19","code_information":[{"code":"Sx00-5424-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303261","type":"LOCAL"},{"code":"522218","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303261 = Hospital System Supply Identifier | 522218 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT19","code_information":[{"code":"Sx00-5424-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303265","type":"LOCAL"},{"code":"522222","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303265 = Hospital System Supply Identifier | 522222 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT16","code_information":[{"code":"Sx00-5424-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303264","type":"LOCAL"},{"code":"522221","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303264 = Hospital System Supply Identifier | 522221 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT13","code_information":[{"code":"Sx00-5424-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303263","type":"LOCAL"},{"code":"522220","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303263 = Hospital System Supply Identifier | 522220 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT9","code_information":[{"code":"Sx00-5424-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303262","type":"LOCAL"},{"code":"522219","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303262 = Hospital System Supply Identifier | 522219 = Lawson ID"}]},{"description":"IMP FLX PRLONG CONG ART SURF S","code_information":[{"code":"Sx00-5424-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662235","type":"LOCAL"},{"code":"446485","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662235 = Hospital System Supply Identifier | 446485 = Lawson ID"}]},{"description":"SURFACE ARTICULAR SZ 1.2 RT","code_information":[{"code":"Sx00-5424-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178546","type":"LOCAL"},{"code":"366330","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178546 = Hospital System Supply Identifier | 366330 = Lawson ID"}]},{"description":"SURFACE ARTICULAR SZ 1.2 9MM","code_information":[{"code":"Sx00-5424-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178547","type":"LOCAL"},{"code":"366333","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178547 = Hospital System Supply Identifier | 366333 = Lawson ID"}]},{"description":"IMP FLX PRLONG CONG ART SURF S","code_information":[{"code":"Sx00-5424-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"406895","type":"LOCAL"},{"code":"446486","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 406895 = Hospital System Supply Identifier | 446486 = Lawson ID"}]},{"description":"IMP FLX PRLONG CONG ART SURF S","code_information":[{"code":"Sx00-5424-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179063","type":"LOCAL"},{"code":"446487","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179063 = Hospital System Supply Identifier | 446487 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ1/2-RT19","code_information":[{"code":"Sx00-5424-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303266","type":"LOCAL"},{"code":"522223","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303266 = Hospital System Supply Identifier | 522223 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PL 345 RT 9","code_information":[{"code":"Sx00-5424-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179015","type":"LOCAL"},{"code":"441613","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179015 = Hospital System Supply Identifier | 441613 = Lawson ID"}]},{"description":"IMP FLX PRLONG CONG ART SURF S","code_information":[{"code":"Sx00-5424-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"363159","type":"LOCAL"},{"code":"446488","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 363159 = Hospital System Supply Identifier | 446488 = Lawson ID"}]},{"description":"IMP FLX PRLONG CONG ART SURF S","code_information":[{"code":"Sx00-5424-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179064","type":"LOCAL"},{"code":"446489","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179064 = Hospital System Supply Identifier | 446489 = Lawson ID"}]},{"description":"IMP FLX PRLONG CONG ART SURF S","code_information":[{"code":"Sx00-5424-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"476864","type":"LOCAL"},{"code":"446490","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 476864 = Hospital System Supply Identifier | 446490 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTCSZ3/4/5-RT19","code_information":[{"code":"Sx00-5424-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303267","type":"LOCAL"},{"code":"522224","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303267 = Hospital System Supply Identifier | 522224 = Lawson ID"}]},{"description":"INSERT ARTICULAR 1-2 9MM CONGRUENT UHMWPE KNEE TIBIA RIGHT NATURAL-KNEE II","code_information":[{"code":"Sx00-5425-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1097416","type":"LOCAL"},{"code":"S652293","type":"LOCAL"}],"standard_charges":[{"gross_charge":997.5,"discounted_cash":349.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1097416 = Hospital System Supply Identifier | S652293 = Lawson ID"}]},{"description":"INSERT ARTICULAR 1-2 11MM CONGRUENT UHMWPE KNEE TIBIA RIGHT NATURAL-KNEE II","code_information":[{"code":"Sx00-5425-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1097415","type":"LOCAL"},{"code":"S652294","type":"LOCAL"}],"standard_charges":[{"gross_charge":997.5,"discounted_cash":349.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1097415 = Hospital System Supply Identifier | S652294 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-LT19","code_information":[{"code":"Sx00-5428-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303271","type":"LOCAL"},{"code":"522228","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303271 = Hospital System Supply Identifier | 522228 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-LT16","code_information":[{"code":"Sx00-5428-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303270","type":"LOCAL"},{"code":"522227","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303270 = Hospital System Supply Identifier | 522227 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-LT11","code_information":[{"code":"Sx00-5428-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303268","type":"LOCAL"},{"code":"522225","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303268 = Hospital System Supply Identifier | 522225 = Lawson ID"}]},{"description":"INSERT PROLONG ULTRA 9MM","code_information":[{"code":"Sx00-5428-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164493","type":"LOCAL"},{"code":"370025","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 164493 = Hospital System Supply Identifier | 370025 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-LT13","code_information":[{"code":"Sx00-5428-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303269","type":"LOCAL"},{"code":"522226","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303269 = Hospital System Supply Identifier | 522226 = Lawson ID"}]},{"description":"INSERT TIB FLEX SZ1-2 9MM LT","code_information":[{"code":"Sx00-5428-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164241","type":"LOCAL"},{"code":"369326","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 164241 = Hospital System Supply Identifier | 369326 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PL 12 LT 11","code_information":[{"code":"Sx00-5428-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328268","type":"LOCAL"},{"code":"441614","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 328268 = Hospital System Supply Identifier | 441614 = Lawson ID"}]},{"description":"IMP KNEE GSF NP FLEX FEM SIZE","code_information":[{"code":"Sx00-5428-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"445183","type":"LOCAL"},{"code":"446493","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 445183 = Hospital System Supply Identifier | 446493 = Lawson ID"}]},{"description":"IMP KNEE FLX PROLONG UL CONG A","code_information":[{"code":"Sx00-5428-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662236","type":"LOCAL"},{"code":"446494","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662236 = Hospital System Supply Identifier | 446494 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ1/2-LT16","code_information":[{"code":"Sx00-5428-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303272","type":"LOCAL"},{"code":"522229","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303272 = Hospital System Supply Identifier | 522229 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PL 345 LT 9","code_information":[{"code":"Sx00-5428-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179016","type":"LOCAL"},{"code":"441615","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179016 = Hospital System Supply Identifier | 441615 = Lawson ID"}]},{"description":"IMP KNEE PRLONG UL CONG ART SU","code_information":[{"code":"Sx00-5428-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662237","type":"LOCAL"},{"code":"446495","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662237 = Hospital System Supply Identifier | 446495 = Lawson ID"}]},{"description":"IMP KNEE PRLONG UL CONG ART SU","code_information":[{"code":"Sx00-5428-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662238","type":"LOCAL"},{"code":"446496","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662238 = Hospital System Supply Identifier | 446496 = Lawson ID"}]},{"description":"IMP FLX PRLONG UL CONG ART SUR","code_information":[{"code":"Sx00-5428-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662239","type":"LOCAL"},{"code":"446497","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662239 = Hospital System Supply Identifier | 446497 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTCSZ3/4/5-LT16","code_information":[{"code":"Sx00-5428-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303273","type":"LOCAL"},{"code":"522230","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303273 = Hospital System Supply Identifier | 522230 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT16","code_information":[{"code":"Sx00-5428-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303276","type":"LOCAL"},{"code":"522233","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303276 = Hospital System Supply Identifier | 522233 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT13","code_information":[{"code":"Sx00-5428-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303275","type":"LOCAL"},{"code":"522232","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303275 = Hospital System Supply Identifier | 522232 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT19","code_information":[{"code":"Sx00-5428-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303277","type":"LOCAL"},{"code":"522234","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303277 = Hospital System Supply Identifier | 522234 = Lawson ID"}]},{"description":"INSERT PROLONG ULTRA 11MM","code_information":[{"code":"Sx00-5428-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164484","type":"LOCAL"},{"code":"370012","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 164484 = Hospital System Supply Identifier | 370012 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT9","code_information":[{"code":"Sx00-5428-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303274","type":"LOCAL"},{"code":"522231","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303274 = Hospital System Supply Identifier | 522231 = Lawson ID"}]},{"description":"IMP FLX PRLONG UL CONG ART SUR","code_information":[{"code":"Sx00-5428-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179065","type":"LOCAL"},{"code":"446499","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179065 = Hospital System Supply Identifier | 446499 = Lawson ID"}]},{"description":"IMP FLX PRLONG UL CONG ART SUR","code_information":[{"code":"Sx00-5428-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662241","type":"LOCAL"},{"code":"446500","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662241 = Hospital System Supply Identifier | 446500 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PL 12 RT 9MM","code_information":[{"code":"Sx00-5428-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328269","type":"LOCAL"},{"code":"441616","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 328269 = Hospital System Supply Identifier | 441616 = Lawson ID"}]},{"description":"IMPFLX PRLONG UL CONG ART SURF","code_information":[{"code":"Sx00-5428-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662240","type":"LOCAL"},{"code":"446498","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662240 = Hospital System Supply Identifier | 446498 = Lawson ID"}]},{"description":"IMP FLX PRLONG UL CONG ART SUR","code_information":[{"code":"Sx00-5428-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662242","type":"LOCAL"},{"code":"446501","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662242 = Hospital System Supply Identifier | 446501 = Lawson ID"}]},{"description":"SURFACE ARTICULAR SZ 3/4/5 RT","code_information":[{"code":"Sx00-5428-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325892","type":"LOCAL"},{"code":"366368","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325892 = Hospital System Supply Identifier | 366368 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTCSZ3/4/5-RT19","code_information":[{"code":"Sx00-5428-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303278","type":"LOCAL"},{"code":"522235","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303278 = Hospital System Supply Identifier | 522235 = Lawson ID"}]},{"description":"IMP FLX PRLNG UL CONG ART SURF","code_information":[{"code":"Sx00-5428-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662244","type":"LOCAL"},{"code":"446504","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662244 = Hospital System Supply Identifier | 446504 = Lawson ID"}]},{"description":"SURFACE ARTICULAR SZ 3/4/5","code_information":[{"code":"Sx00-5428-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169984","type":"LOCAL"},{"code":"366327","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 169984 = Hospital System Supply Identifier | 366327 = Lawson ID"}]},{"description":"IMP FLX PRLONG UL CONG ART SUR","code_information":[{"code":"Sx00-5428-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662243","type":"LOCAL"},{"code":"446503","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662243 = Hospital System Supply Identifier | 446503 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE TM MED 31X31","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326294","type":"LOCAL"},{"code":"395480","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326294 = Hospital System Supply Identifier | 395480 = Lawson ID"}]},{"description":"IMP KNEE TIB MED 35X31MM","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"330203","type":"LOCAL"},{"code":"421386","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 330203 = Hospital System Supply Identifier | 421386 = Lawson ID"}]},{"description":"KNEE CONE TIBIAL LARGE LEFT 51","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196905","type":"LOCAL"},{"code":"425149","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 196905 = Hospital System Supply Identifier | 425149 = Lawson ID"}]},{"description":"IMP KNEE CONE LG RT 51X34X25MM","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327791","type":"LOCAL"},{"code":"425965","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 327791 = Hospital System Supply Identifier | 425965 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE TM MED 41X34","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327808","type":"LOCAL"},{"code":"427247","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 327808 = Hospital System Supply Identifier | 427247 = Lawson ID"}]},{"description":"IMP TIB CONE MED TM 46X34MM","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"199311","type":"LOCAL"},{"code":"446832","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 199311 = Hospital System Supply Identifier | 446832 = Lawson ID"}]},{"description":"IMP TIB CONE LG TM LT 55X36MM","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202226","type":"LOCAL"},{"code":"452324","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202226 = Hospital System Supply Identifier | 452324 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE LG 55X36 RT","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322575","type":"LOCAL"},{"code":"535789","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322575 = Hospital System Supply Identifier | 535789 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE LG 60X36 LT","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322576","type":"LOCAL"},{"code":"535790","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322576 = Hospital System Supply Identifier | 535790 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE LG 60X36 RT","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322577","type":"LOCAL"},{"code":"535791","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322577 = Hospital System Supply Identifier | 535791 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE LG 67X38 LT","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322578","type":"LOCAL"},{"code":"535792","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322578 = Hospital System Supply Identifier | 535792 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE LG 67X38 RT","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322579","type":"LOCAL"},{"code":"535793","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322579 = Hospital System Supply Identifier | 535793 = Lawson ID"}]},{"description":"TM FEM DIAPHYSEAL CONE 30 SMAL","code_information":[{"code":"Sx00-5450-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"662245","type":"LOCAL"},{"code":"446507","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662245 = Hospital System Supply Identifier | 446507 = Lawson ID"}]},{"description":"TM FEM DPHSEAL CONE 30MM SM","code_information":[{"code":"Sx00-5450-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662246","type":"LOCAL"},{"code":"446508","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662246 = Hospital System Supply Identifier | 446508 = Lawson ID"}]},{"description":"IMP FEM CONE DPHSEAL MED RT 30","code_information":[{"code":"Sx00-5450-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322593","type":"LOCAL"},{"code":"535807","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322593 = Hospital System Supply Identifier | 535807 = Lawson ID"}]},{"description":"IMP FEM CONE DPHSEAL MED LT 30","code_information":[{"code":"Sx00-5450-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322592","type":"LOCAL"},{"code":"535806","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322592 = Hospital System Supply Identifier | 535806 = Lawson ID"}]},{"description":"IMP FEM CONE LG TM LT 30MM","code_information":[{"code":"Sx00-5450-019","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202222","type":"LOCAL"},{"code":"452320","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202222 = Hospital System Supply Identifier | 452320 = Lawson ID"}]},{"description":"IMP FEM CONE DPHSEAL LG RT 30","code_information":[{"code":"Sx00-5450-019","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322594","type":"LOCAL"},{"code":"535808","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322594 = Hospital System Supply Identifier | 535808 = Lawson ID"}]},{"description":"IMP FEM CONE MTPHSEAL SM LT 35","code_information":[{"code":"Sx00-5450-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322595","type":"LOCAL"},{"code":"535809","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322595 = Hospital System Supply Identifier | 535809 = Lawson ID"}]},{"description":"IMP FEM CONE MTPHSEAL SM RT 35","code_information":[{"code":"Sx00-5450-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322596","type":"LOCAL"},{"code":"535810","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322596 = Hospital System Supply Identifier | 535810 = Lawson ID"}]},{"description":"IMP FEM CONE MTPHSEAL MD LT 35","code_information":[{"code":"Sx00-5450-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322597","type":"LOCAL"},{"code":"535811","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322597 = Hospital System Supply Identifier | 535811 = Lawson ID"}]},{"description":"IMP FEM CONE MTPHSEAL MD RT 35","code_information":[{"code":"Sx00-5450-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322598","type":"LOCAL"},{"code":"535812","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322598 = Hospital System Supply Identifier | 535812 = Lawson ID"}]},{"description":"IMP FEM CONE LG TM RT 35MM","code_information":[{"code":"Sx00-5450-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202224","type":"LOCAL"},{"code":"452322","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202224 = Hospital System Supply Identifier | 452322 = Lawson ID"}]},{"description":"IMP FEM CONE LG TM LT 35MM","code_information":[{"code":"Sx00-5450-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202223","type":"LOCAL"},{"code":"452321","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202223 = Hospital System Supply Identifier | 452321 = Lawson ID"}]},{"description":"IMP TIB CONE FULL XSM SZ48-15","code_information":[{"code":"Sx00-5450-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322599","type":"LOCAL"},{"code":"535813","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322599 = Hospital System Supply Identifier | 535813 = Lawson ID"}]},{"description":"IMP TIB CONE FULL SM SZ52-15","code_information":[{"code":"Sx00-5450-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322600","type":"LOCAL"},{"code":"535814","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322600 = Hospital System Supply Identifier | 535814 = Lawson ID"}]},{"description":"IMP TIB CONE STD SZ59 30MM MED","code_information":[{"code":"Sx00-5450-059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329610","type":"LOCAL"},{"code":"353708","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329610 = Hospital System Supply Identifier | 353708 = Lawson ID"}]},{"description":"IMP TIB CONE SZ59 STP 30/15 LT","code_information":[{"code":"Sx00-5450-059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322602","type":"LOCAL"},{"code":"535816","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322602 = Hospital System Supply Identifier | 535816 = Lawson ID"}]},{"description":"IMP TIB CONE SZ59 STP 15/30 RT","code_information":[{"code":"Sx00-5450-059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322603","type":"LOCAL"},{"code":"535817","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322603 = Hospital System Supply Identifier | 535817 = Lawson ID"}]},{"description":"IMP TIB CONE SZ67 STP 30/15 LT","code_information":[{"code":"Sx00-5450-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322605","type":"LOCAL"},{"code":"535819","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322605 = Hospital System Supply Identifier | 535819 = Lawson ID"}]},{"description":"IMP TIB CONE SZ67 STP 15/30 LT","code_information":[{"code":"Sx00-5450-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322606","type":"LOCAL"},{"code":"535820","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322606 = Hospital System Supply Identifier | 535820 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE TRAB SZ67 15","code_information":[{"code":"Sx00-5450-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202227","type":"LOCAL"},{"code":"452325","type":"LOCAL"}],"standard_charges":[{"gross_charge":12840.0,"discounted_cash":4494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202227 = Hospital System Supply Identifier | 452325 = Lawson ID"}]},{"description":"PLATE EXTERNAL FIXATION BURR TEMPLATE","code_information":[{"code":"Sx00-5452-013","type":"CDM"},{"code":"272","type":"RC"},{"code":"1100355","type":"LOCAL"},{"code":"S657300","type":"LOCAL"}],"standard_charges":[{"gross_charge":4801.12,"discounted_cash":1680.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1100355 = Hospital System Supply Identifier | S657300 = Lawson ID"}]},{"description":"BUR TIB CONE LG","code_information":[{"code":"Sx00-5452-013","type":"CDM"},{"code":"272","type":"RC"},{"code":"199607","type":"LOCAL"},{"code":"447589","type":"LOCAL"}],"standard_charges":[{"gross_charge":1455.3,"discounted_cash":509.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 199607 = Hospital System Supply Identifier | 447589 = Lawson ID"}]},{"description":"ALGRFT CARTLG NAT TISS DENOVO","code_information":[{"code":"Sx00-5606-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"455483","type":"LOCAL"},{"code":"453691","type":"LOCAL"}],"standard_charges":[{"gross_charge":19707.4,"discounted_cash":6897.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 455483 = Hospital System Supply Identifier | 453691 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZC","code_information":[{"code":"Sx00-5750-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325561","type":"LOCAL"},{"code":"354410","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325561 = Hospital System Supply Identifier | 354410 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZC","code_information":[{"code":"Sx00-5750-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325562","type":"LOCAL"},{"code":"354411","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325562 = Hospital System Supply Identifier | 354411 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZC","code_information":[{"code":"Sx00-5750-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325564","type":"LOCAL"},{"code":"354414","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325564 = Hospital System Supply Identifier | 354414 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZC","code_information":[{"code":"Sx00-5750-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325565","type":"LOCAL"},{"code":"354416","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325565 = Hospital System Supply Identifier | 354416 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZD","code_information":[{"code":"Sx00-5750-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324891","type":"LOCAL"},{"code":"330181","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 324891 = Hospital System Supply Identifier | 330181 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZD","code_information":[{"code":"Sx00-5750-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178395","type":"LOCAL"},{"code":"333588","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178395 = Hospital System Supply Identifier | 333588 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZD","code_information":[{"code":"Sx00-5750-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178437","type":"LOCAL"},{"code":"343824","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178437 = Hospital System Supply Identifier | 343824 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZD","code_information":[{"code":"Sx00-5750-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325465","type":"LOCAL"},{"code":"348627","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325465 = Hospital System Supply Identifier | 348627 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZE","code_information":[{"code":"Sx00-5750-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179185","type":"LOCAL"},{"code":"333589","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179185 = Hospital System Supply Identifier | 333589 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZE","code_information":[{"code":"Sx00-5750-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178445","type":"LOCAL"},{"code":"345973","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178445 = Hospital System Supply Identifier | 345973 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZE","code_information":[{"code":"Sx00-5750-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178484","type":"LOCAL"},{"code":"354412","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178484 = Hospital System Supply Identifier | 354412 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZE","code_information":[{"code":"Sx00-5750-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178485","type":"LOCAL"},{"code":"354417","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178485 = Hospital System Supply Identifier | 354417 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZF","code_information":[{"code":"Sx00-5750-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325563","type":"LOCAL"},{"code":"354413","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325563 = Hospital System Supply Identifier | 354413 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZF","code_information":[{"code":"Sx00-5750-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325549","type":"LOCAL"},{"code":"354395","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325549 = Hospital System Supply Identifier | 354395 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZF","code_information":[{"code":"Sx00-5750-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178440","type":"LOCAL"},{"code":"345393","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178440 = Hospital System Supply Identifier | 345393 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZF","code_information":[{"code":"Sx00-5750-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325466","type":"LOCAL"},{"code":"348628","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325466 = Hospital System Supply Identifier | 348628 = Lawson ID"}]},{"description":"IMP KNEE-C FEM NXGN SZG LT","code_information":[{"code":"Sx00-5750-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329889","type":"LOCAL"},{"code":"395481","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329889 = Hospital System Supply Identifier | 395481 = Lawson ID"}]},{"description":"IMP KNEE-C FEM NXGN MNS SZG LT","code_information":[{"code":"Sx00-5750-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329890","type":"LOCAL"},{"code":"395482","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329890 = Hospital System Supply Identifier | 395482 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZG","code_information":[{"code":"Sx00-5750-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327192","type":"LOCAL"},{"code":"412509","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 327192 = Hospital System Supply Identifier | 412509 = Lawson ID"}]},{"description":"IMP KNEE-C FEM NXGN MNS SZG RT","code_information":[{"code":"Sx00-5750-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303279","type":"LOCAL"},{"code":"522236","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303279 = Hospital System Supply Identifier | 522236 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZC","code_information":[{"code":"Sx00-5764-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194941","type":"LOCAL"},{"code":"360589","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194941 = Hospital System Supply Identifier | 360589 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZC","code_information":[{"code":"Sx00-5764-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"171770","type":"LOCAL"},{"code":"412510","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 171770 = Hospital System Supply Identifier | 412510 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZD","code_information":[{"code":"Sx00-5764-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"158789","type":"LOCAL"},{"code":"317223","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 158789 = Hospital System Supply Identifier | 317223 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZD","code_information":[{"code":"Sx00-5764-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169921","type":"LOCAL"},{"code":"351669","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 169921 = Hospital System Supply Identifier | 351669 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZE","code_information":[{"code":"Sx00-5764-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169893","type":"LOCAL"},{"code":"344611","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 169893 = Hospital System Supply Identifier | 344611 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZE","code_information":[{"code":"Sx00-5764-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"159842","type":"LOCAL"},{"code":"344612","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 159842 = Hospital System Supply Identifier | 344612 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZF","code_information":[{"code":"Sx00-5764-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"160639","type":"LOCAL"},{"code":"351666","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 160639 = Hospital System Supply Identifier | 351666 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZF","code_information":[{"code":"Sx00-5764-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"160640","type":"LOCAL"},{"code":"351668","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 160640 = Hospital System Supply Identifier | 351668 = Lawson ID"}]},{"description":"IMP KNEE-C FEM COMP NXGN RTSZG","code_information":[{"code":"Sx00-5764-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"170233","type":"LOCAL"},{"code":"395483","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 170233 = Hospital System Supply Identifier | 395483 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZG","code_information":[{"code":"Sx00-5764-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"160606","type":"LOCAL"},{"code":"351578","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 160606 = Hospital System Supply Identifier | 351578 = Lawson ID"}]},{"description":"CLAMP EXTERNAL FIXATION NSTRL REPLACEMENT O RING SS KNEE PATELLA AOR MG II","code_information":[{"code":"Sx00-5781-045","type":"CDM"},{"code":"272","type":"RC"},{"code":"1092613","type":"LOCAL"},{"code":"S371986","type":"LOCAL"}],"standard_charges":[{"gross_charge":297.5,"discounted_cash":104.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1092613 = Hospital System Supply Identifier | S371986 = Lawson ID"}]},{"description":"INST ROD ALIGN TIB","code_information":[{"code":"Sx00-5785-079","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"449583","type":"LOCAL"},{"code":"314217","type":"LOCAL"}],"standard_charges":[{"gross_charge":262.5,"discounted_cash":91.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 449583 = Hospital System Supply Identifier | 314217 = Lawson ID"}]},{"description":"ROD EXTERNAL FIXATION NSTRL ALIGNMENT COUPLER SS MG II","code_information":[{"code":"Sx00-5785-080","type":"CDM"},{"code":"272","type":"RC"},{"code":"1102289","type":"LOCAL"},{"code":"S76061","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1102289 = Hospital System Supply Identifier | S76061 = Lawson ID"}]},{"description":"IMP KNEE TIB ARTC MG SER1 8MM","code_information":[{"code":"Sx00-5788-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"581884","type":"LOCAL"},{"code":"675996","type":"LOCAL"}],"standard_charges":[{"gross_charge":2788.75,"discounted_cash":976.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 581884 = Hospital System Supply Identifier | 675996 = Lawson ID"}]},{"description":"BIT DRILL M/G UNI KNEE 9MM","code_information":[{"code":"Sx00-5789-049","type":"CDM"},{"code":"272","type":"RC"},{"code":"449582","type":"LOCAL"},{"code":"313632","type":"LOCAL"}],"standard_charges":[{"gross_charge":472.5,"discounted_cash":165.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 449582 = Hospital System Supply Identifier | 313632 = Lawson ID"}]},{"description":"GAUGE M/G TENSION","code_information":[{"code":"Sx00-5789-071","type":"CDM"},{"code":"272","type":"RC"},{"code":"202234","type":"LOCAL"},{"code":"452332","type":"LOCAL"}],"standard_charges":[{"gross_charge":647.5,"discounted_cash":226.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202234 = Hospital System Supply Identifier | 452332 = Lawson ID"}]},{"description":"SCREW HD SS 27MM","code_information":[{"code":"Sx00-5791-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"193183","type":"LOCAL"},{"code":"253689","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":140.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193183 = Hospital System Supply Identifier | 253689 = Lawson ID"}]},{"description":"SCREW HD SS 33MM","code_information":[{"code":"Sx00-5791-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"178423","type":"LOCAL"},{"code":"340083","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178423 = Hospital System Supply Identifier | 340083 = Lawson ID"}]},{"description":"WASHER KT PROX TIB SEG","code_information":[{"code":"Sx00-5850-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"322826","type":"LOCAL"},{"code":"536041","type":"LOCAL"}],"standard_charges":[{"gross_charge":9850.57,"discounted_cash":3447.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322826 = Hospital System Supply Identifier | 536041 = Lawson ID"}]},{"description":"IMP KNEE PROX TIB SEG SZ1","code_information":[{"code":"Sx00-5850-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322827","type":"LOCAL"},{"code":"536042","type":"LOCAL"}],"standard_charges":[{"gross_charge":40612.88,"discounted_cash":14214.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322827 = Hospital System Supply Identifier | 536042 = Lawson ID"}]},{"description":"IMP KNEE PROX TIB SEG SZ2","code_information":[{"code":"Sx00-5850-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322828","type":"LOCAL"},{"code":"536043","type":"LOCAL"}],"standard_charges":[{"gross_charge":40612.88,"discounted_cash":14214.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322828 = Hospital System Supply Identifier | 536043 = Lawson ID"}]},{"description":"IMP KNEE PROX TIB SEG SZ3","code_information":[{"code":"Sx00-5850-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322829","type":"LOCAL"},{"code":"536044","type":"LOCAL"}],"standard_charges":[{"gross_charge":40612.88,"discounted_cash":14214.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322829 = Hospital System Supply Identifier | 536044 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM POLY BOX","code_information":[{"code":"Sx00-5850-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"667568","type":"LOCAL"},{"code":"661679","type":"LOCAL"}],"standard_charges":[{"gross_charge":1852.2,"discounted_cash":648.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 667568 = Hospital System Supply Identifier | 661679 = Lawson ID"}]},{"description":"IMP TIB INS FEMUR SZC","code_information":[{"code":"Sx00-5850-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329671","type":"LOCAL"},{"code":"355936","type":"LOCAL"}],"standard_charges":[{"gross_charge":1766.45,"discounted_cash":618.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329671 = Hospital System Supply Identifier | 355936 = Lawson ID"}]},{"description":"SEG DIST FEM POLY BOX SZ C","code_information":[{"code":"Sx00-5850-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1019417","type":"LOCAL"},{"code":"869365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1852.2,"discounted_cash":648.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1019417 = Hospital System Supply Identifier | 869365 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ B 26","code_information":[{"code":"Sx00-5850-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322834","type":"LOCAL"},{"code":"536049","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322834 = Hospital System Supply Identifier | 536049 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ B 17","code_information":[{"code":"Sx00-5850-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322832","type":"LOCAL"},{"code":"536047","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322832 = Hospital System Supply Identifier | 536047 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ B 23","code_information":[{"code":"Sx00-5850-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322833","type":"LOCAL"},{"code":"536048","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322833 = Hospital System Supply Identifier | 536048 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZB 20MM","code_information":[{"code":"Sx00-5850-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325124","type":"LOCAL"},{"code":"337482","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325124 = Hospital System Supply Identifier | 337482 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZB 12MM","code_information":[{"code":"Sx00-5850-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325123","type":"LOCAL"},{"code":"337481","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325123 = Hospital System Supply Identifier | 337481 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ B 14","code_information":[{"code":"Sx00-5850-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322831","type":"LOCAL"},{"code":"536046","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322831 = Hospital System Supply Identifier | 536046 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP SZC 38MM","code_information":[{"code":"Sx00-5850-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322838","type":"LOCAL"},{"code":"536053","type":"LOCAL"}],"standard_charges":[{"gross_charge":22005.9,"discounted_cash":7702.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322838 = Hospital System Supply Identifier | 536053 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ C 20","code_information":[{"code":"Sx00-5850-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322836","type":"LOCAL"},{"code":"536051","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322836 = Hospital System Supply Identifier | 536051 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ C 12","code_information":[{"code":"Sx00-5850-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322835","type":"LOCAL"},{"code":"536050","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322835 = Hospital System Supply Identifier | 536050 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ C 26","code_information":[{"code":"Sx00-5850-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322837","type":"LOCAL"},{"code":"536052","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322837 = Hospital System Supply Identifier | 536052 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP SZC 23MM","code_information":[{"code":"Sx00-5850-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325922","type":"LOCAL"},{"code":"370200","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325922 = Hospital System Supply Identifier | 370200 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP SZC 17MM","code_information":[{"code":"Sx00-5850-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325536","type":"LOCAL"},{"code":"353710","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325536 = Hospital System Supply Identifier | 353710 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP SZC 14MM","code_information":[{"code":"Sx00-5850-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326081","type":"LOCAL"},{"code":"380807","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326081 = Hospital System Supply Identifier | 380807 = Lawson ID"}]},{"description":"WASHER FLAT SEG TM HIP 4","code_information":[{"code":"Sx00-5850-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"322839","type":"LOCAL"},{"code":"536054","type":"LOCAL"}],"standard_charges":[{"gross_charge":6745.9,"discounted_cash":2361.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322839 = Hospital System Supply Identifier | 536054 = Lawson ID"}]},{"description":"WASHER FLAT SEG TM HIP 7","code_information":[{"code":"Sx00-5850-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"322840","type":"LOCAL"},{"code":"536055","type":"LOCAL"}],"standard_charges":[{"gross_charge":6745.9,"discounted_cash":2361.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322840 = Hospital System Supply Identifier | 536055 = Lawson ID"}]},{"description":"WASHER CRV SEG TM HIP 4","code_information":[{"code":"Sx00-5850-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"322841","type":"LOCAL"},{"code":"536056","type":"LOCAL"}],"standard_charges":[{"gross_charge":6745.9,"discounted_cash":2361.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322841 = Hospital System Supply Identifier | 536056 = Lawson ID"}]},{"description":"IMP KNEE FEM BDY PROX SEG 38","code_information":[{"code":"Sx00-5850-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322842","type":"LOCAL"},{"code":"536057","type":"LOCAL"}],"standard_charges":[{"gross_charge":31630.06,"discounted_cash":11070.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322842 = Hospital System Supply Identifier | 536057 = Lawson ID"}]},{"description":"IMP KNEE FEM BDY PROX SEG 46","code_information":[{"code":"Sx00-5850-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322843","type":"LOCAL"},{"code":"536058","type":"LOCAL"}],"standard_charges":[{"gross_charge":31630.06,"discounted_cash":11070.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322843 = Hospital System Supply Identifier | 536058 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ D 26","code_information":[{"code":"Sx00-5850-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322849","type":"LOCAL"},{"code":"536064","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322849 = Hospital System Supply Identifier | 536064 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ D 23","code_information":[{"code":"Sx00-5850-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322848","type":"LOCAL"},{"code":"536063","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322848 = Hospital System Supply Identifier | 536063 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ D 20","code_information":[{"code":"Sx00-5850-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322847","type":"LOCAL"},{"code":"536062","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322847 = Hospital System Supply Identifier | 536062 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ D 14","code_information":[{"code":"Sx00-5850-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322845","type":"LOCAL"},{"code":"536060","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322845 = Hospital System Supply Identifier | 536060 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ D 12","code_information":[{"code":"Sx00-5850-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322844","type":"LOCAL"},{"code":"536059","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322844 = Hospital System Supply Identifier | 536059 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ D 17","code_information":[{"code":"Sx00-5850-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322846","type":"LOCAL"},{"code":"536061","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322846 = Hospital System Supply Identifier | 536061 = Lawson ID"}]},{"description":"IMP KNEE SEGDIST FEM SZ B RT","code_information":[{"code":"Sx00-5850-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"667569","type":"LOCAL"},{"code":"661681","type":"LOCAL"}],"standard_charges":[{"gross_charge":37935.59,"discounted_cash":13277.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 667569 = Hospital System Supply Identifier | 661681 = Lawson ID"}]},{"description":"IMP KNEE DST FEM SEG SZB LT","code_information":[{"code":"Sx00-5850-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"582447","type":"LOCAL"},{"code":"676559","type":"LOCAL"}],"standard_charges":[{"gross_charge":37935.59,"discounted_cash":13277.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 582447 = Hospital System Supply Identifier | 676559 = Lawson ID"}]},{"description":"IMP KNEE DST FEM SEG SZC RT","code_information":[{"code":"Sx00-5850-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"582445","type":"LOCAL"},{"code":"676557","type":"LOCAL"}],"standard_charges":[{"gross_charge":37935.59,"discounted_cash":13277.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 582445 = Hospital System Supply Identifier | 676557 = Lawson ID"}]},{"description":"IMP KNEE DST FEM SEG SZC LT","code_information":[{"code":"Sx00-5850-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"582446","type":"LOCAL"},{"code":"676558","type":"LOCAL"}],"standard_charges":[{"gross_charge":37935.59,"discounted_cash":13277.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 582446 = Hospital System Supply Identifier | 676558 = Lawson ID"}]},{"description":"IMP KNEE SEG INTCAL 55","code_information":[{"code":"Sx00-5850-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322851","type":"LOCAL"},{"code":"536066","type":"LOCAL"}],"standard_charges":[{"gross_charge":16154.25,"discounted_cash":5653.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322851 = Hospital System Supply Identifier | 536066 = Lawson ID"}]},{"description":"IMP KNEE SEG INTCAL 45","code_information":[{"code":"Sx00-5850-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322850","type":"LOCAL"},{"code":"536065","type":"LOCAL"}],"standard_charges":[{"gross_charge":16154.25,"discounted_cash":5653.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322850 = Hospital System Supply Identifier | 536065 = Lawson ID"}]},{"description":"IMP KNEE SEG INTCAL 65","code_information":[{"code":"Sx00-5850-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322852","type":"LOCAL"},{"code":"536067","type":"LOCAL"}],"standard_charges":[{"gross_charge":16154.25,"discounted_cash":5653.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322852 = Hospital System Supply Identifier | 536067 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 180","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322861","type":"LOCAL"},{"code":"536076","type":"LOCAL"}],"standard_charges":[{"gross_charge":16912.87,"discounted_cash":5919.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322861 = Hospital System Supply Identifier | 536076 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 200","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322862","type":"LOCAL"},{"code":"536077","type":"LOCAL"}],"standard_charges":[{"gross_charge":16912.87,"discounted_cash":5919.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322862 = Hospital System Supply Identifier | 536077 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 220","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322863","type":"LOCAL"},{"code":"536078","type":"LOCAL"}],"standard_charges":[{"gross_charge":16734.37,"discounted_cash":5857.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322863 = Hospital System Supply Identifier | 536078 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 120","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322858","type":"LOCAL"},{"code":"536073","type":"LOCAL"}],"standard_charges":[{"gross_charge":16734.37,"discounted_cash":5857.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322858 = Hospital System Supply Identifier | 536073 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 45","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322865","type":"LOCAL"},{"code":"536080","type":"LOCAL"}],"standard_charges":[{"gross_charge":16734.37,"discounted_cash":5857.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322865 = Hospital System Supply Identifier | 536080 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 55","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322866","type":"LOCAL"},{"code":"536081","type":"LOCAL"}],"standard_charges":[{"gross_charge":16734.37,"discounted_cash":5857.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322866 = Hospital System Supply Identifier | 536081 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 35","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322864","type":"LOCAL"},{"code":"536079","type":"LOCAL"}],"standard_charges":[{"gross_charge":16734.37,"discounted_cash":5857.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322864 = Hospital System Supply Identifier | 536079 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 160","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322860","type":"LOCAL"},{"code":"536075","type":"LOCAL"}],"standard_charges":[{"gross_charge":16912.87,"discounted_cash":5919.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322860 = Hospital System Supply Identifier | 536075 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 80","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322856","type":"LOCAL"},{"code":"536071","type":"LOCAL"}],"standard_charges":[{"gross_charge":16734.37,"discounted_cash":5857.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322856 = Hospital System Supply Identifier | 536071 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 100","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322857","type":"LOCAL"},{"code":"536072","type":"LOCAL"}],"standard_charges":[{"gross_charge":16734.37,"discounted_cash":5857.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322857 = Hospital System Supply Identifier | 536072 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 60","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322855","type":"LOCAL"},{"code":"536070","type":"LOCAL"}],"standard_charges":[{"gross_charge":16734.37,"discounted_cash":5857.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322855 = Hospital System Supply Identifier | 536070 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 50","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322854","type":"LOCAL"},{"code":"536069","type":"LOCAL"}],"standard_charges":[{"gross_charge":16734.37,"discounted_cash":5857.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322854 = Hospital System Supply Identifier | 536069 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 40","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322853","type":"LOCAL"},{"code":"536068","type":"LOCAL"}],"standard_charges":[{"gross_charge":16734.37,"discounted_cash":5857.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322853 = Hospital System Supply Identifier | 536068 = Lawson ID"}]},{"description":"IMP KNEE SEG TIB/FIB M/F 30MM","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325537","type":"LOCAL"},{"code":"353711","type":"LOCAL"}],"standard_charges":[{"gross_charge":16734.37,"discounted_cash":5857.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325537 = Hospital System Supply Identifier | 353711 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 140","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322859","type":"LOCAL"},{"code":"536074","type":"LOCAL"}],"standard_charges":[{"gross_charge":16734.37,"discounted_cash":5857.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322859 = Hospital System Supply Identifier | 536074 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-M 80","code_information":[{"code":"Sx00-5850-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322867","type":"LOCAL"},{"code":"536082","type":"LOCAL"}],"standard_charges":[{"gross_charge":16154.25,"discounted_cash":5653.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322867 = Hospital System Supply Identifier | 536082 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-M 90","code_information":[{"code":"Sx00-5850-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322868","type":"LOCAL"},{"code":"536083","type":"LOCAL"}],"standard_charges":[{"gross_charge":16154.25,"discounted_cash":5653.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322868 = Hospital System Supply Identifier | 536083 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-M 200","code_information":[{"code":"Sx00-5850-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322869","type":"LOCAL"},{"code":"536084","type":"LOCAL"}],"standard_charges":[{"gross_charge":16154.25,"discounted_cash":5653.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322869 = Hospital System Supply Identifier | 536084 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ E 20","code_information":[{"code":"Sx00-5850-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322873","type":"LOCAL"},{"code":"536088","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322873 = Hospital System Supply Identifier | 536088 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ E 17","code_information":[{"code":"Sx00-5850-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322872","type":"LOCAL"},{"code":"536087","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322872 = Hospital System Supply Identifier | 536087 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ E 23","code_information":[{"code":"Sx00-5850-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322874","type":"LOCAL"},{"code":"536089","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322874 = Hospital System Supply Identifier | 536089 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ E 12","code_information":[{"code":"Sx00-5850-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322870","type":"LOCAL"},{"code":"536085","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322870 = Hospital System Supply Identifier | 536085 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ E 14","code_information":[{"code":"Sx00-5850-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322871","type":"LOCAL"},{"code":"536086","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322871 = Hospital System Supply Identifier | 536086 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ E 26","code_information":[{"code":"Sx00-5850-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322875","type":"LOCAL"},{"code":"536090","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322875 = Hospital System Supply Identifier | 536090 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ F 23","code_information":[{"code":"Sx00-5850-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322880","type":"LOCAL"},{"code":"536095","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322880 = Hospital System Supply Identifier | 536095 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ F 26","code_information":[{"code":"Sx00-5850-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322881","type":"LOCAL"},{"code":"536096","type":"LOCAL"}],"standard_charges":[{"gross_charge":9455.6,"discounted_cash":3309.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322881 = Hospital System Supply Identifier | 536096 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ F 20","code_information":[{"code":"Sx00-5850-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322879","type":"LOCAL"},{"code":"536094","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322879 = Hospital System Supply Identifier | 536094 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ F 17","code_information":[{"code":"Sx00-5850-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322878","type":"LOCAL"},{"code":"536093","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322878 = Hospital System Supply Identifier | 536093 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ F 14","code_information":[{"code":"Sx00-5850-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322877","type":"LOCAL"},{"code":"536092","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322877 = Hospital System Supply Identifier | 536092 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ F 12","code_information":[{"code":"Sx00-5850-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322876","type":"LOCAL"},{"code":"536091","type":"LOCAL"}],"standard_charges":[{"gross_charge":9732.8,"discounted_cash":3406.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322876 = Hospital System Supply Identifier | 536091 = Lawson ID"}]},{"description":"KIT IMP INS FEM HNG SVC SZB","code_information":[{"code":"Sx00-5850-070","type":"CDM"},{"code":"272","type":"RC"},{"code":"322882","type":"LOCAL"},{"code":"536097","type":"LOCAL"}],"standard_charges":[{"gross_charge":10535.7,"discounted_cash":3687.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322882 = Hospital System Supply Identifier | 536097 = Lawson ID"}]},{"description":"KIT IMP INS FEM HNG SVC SZ C","code_information":[{"code":"Sx00-5850-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"329859","type":"LOCAL"},{"code":"389850","type":"LOCAL"}],"standard_charges":[{"gross_charge":10535.7,"discounted_cash":3687.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329859 = Hospital System Supply Identifier | 389850 = Lawson ID"}]},{"description":"KIT TKR B STRL LF HINGE SERVIC","code_information":[{"code":"Sx00-5850-071","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"945505","type":"LOCAL"},{"code":"830110","type":"LOCAL"}],"standard_charges":[{"gross_charge":10535.7,"discounted_cash":3687.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 945505 = Hospital System Supply Identifier | 830110 = Lawson ID"}]},{"description":"SEG DIST FEM HINGE SZ C","code_information":[{"code":"Sx00-5850-071","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1019418","type":"LOCAL"},{"code":"869366","type":"LOCAL"}],"standard_charges":[{"gross_charge":10535.7,"discounted_cash":3687.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1019418 = Hospital System Supply Identifier | 869366 = Lawson ID"}]},{"description":"KIT SEG SHIELD HNG SVC SZF","code_information":[{"code":"Sx00-5850-075","type":"CDM"},{"code":"272","type":"RC"},{"code":"322887","type":"LOCAL"},{"code":"536102","type":"LOCAL"}],"standard_charges":[{"gross_charge":8962.8,"discounted_cash":3136.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322887 = Hospital System Supply Identifier | 536102 = Lawson ID"}]},{"description":"KIT SEG SHIELD HNG SVC SZE","code_information":[{"code":"Sx00-5850-075","type":"CDM"},{"code":"272","type":"RC"},{"code":"322886","type":"LOCAL"},{"code":"536101","type":"LOCAL"}],"standard_charges":[{"gross_charge":8962.8,"discounted_cash":3136.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322886 = Hospital System Supply Identifier | 536101 = Lawson ID"}]},{"description":"KIT SEG SHIELD HNG SVC SZD","code_information":[{"code":"Sx00-5850-075","type":"CDM"},{"code":"272","type":"RC"},{"code":"322885","type":"LOCAL"},{"code":"536100","type":"LOCAL"}],"standard_charges":[{"gross_charge":8962.8,"discounted_cash":3136.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322885 = Hospital System Supply Identifier | 536100 = Lawson ID"}]},{"description":"KIT SEG SHIELD HNG SVC SZC","code_information":[{"code":"Sx00-5850-075","type":"CDM"},{"code":"272","type":"RC"},{"code":"322884","type":"LOCAL"},{"code":"536099","type":"LOCAL"}],"standard_charges":[{"gross_charge":8962.8,"discounted_cash":3136.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322884 = Hospital System Supply Identifier | 536099 = Lawson ID"}]},{"description":"KIT SEG SHIELD HNG SVC SZB","code_information":[{"code":"Sx00-5850-075","type":"CDM"},{"code":"272","type":"RC"},{"code":"322883","type":"LOCAL"},{"code":"536098","type":"LOCAL"}],"standard_charges":[{"gross_charge":8962.8,"discounted_cash":3136.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322883 = Hospital System Supply Identifier | 536098 = Lawson ID"}]},{"description":"WASHER ORTHOPEDIC FLAT 4MM TRABECULAR METAL HIP PROXIMAL","code_information":[{"code":"Sx00-5851-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1113647","type":"LOCAL"},{"code":"S651506","type":"LOCAL"}],"standard_charges":[{"gross_charge":1680.52,"discounted_cash":588.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1113647 = Hospital System Supply Identifier | S651506 = Lawson ID"}]},{"description":"WASHER ORTHOPEDIC FLAT 7MM TRABECULAR METAL HIP PROXIMAL","code_information":[{"code":"Sx00-5851-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1113648","type":"LOCAL"},{"code":"S651507","type":"LOCAL"}],"standard_charges":[{"gross_charge":1212.75,"discounted_cash":424.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1113648 = Hospital System Supply Identifier | S651507 = Lawson ID"}]},{"description":"WASHER ORTHOPEDIC CURVE 4MM TRABECULAR METAL HIP","code_information":[{"code":"Sx00-5851-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1113646","type":"LOCAL"},{"code":"S651508","type":"LOCAL"}],"standard_charges":[{"gross_charge":2885.75,"discounted_cash":1010.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1113646 = Hospital System Supply Identifier | S651508 = Lawson ID"}]},{"description":"BRACE ANKLE EXCELERATOR 9.5IN","code_information":[{"code":"Sx00-5852-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325125","type":"LOCAL"},{"code":"337483","type":"LOCAL"}],"standard_charges":[{"gross_charge":11453.05,"discounted_cash":4008.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325125 = Hospital System Supply Identifier | 337483 = Lawson ID"}]},{"description":"IMP KNEE TOT STEM COLLAR 35MM","code_information":[{"code":"Sx00-5852-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329611","type":"LOCAL"},{"code":"353712","type":"LOCAL"}],"standard_charges":[{"gross_charge":11453.05,"discounted_cash":4008.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329611 = Hospital System Supply Identifier | 353712 = Lawson ID"}]},{"description":"IMP KNEE STEM COLLAR 25MM","code_information":[{"code":"Sx00-5852-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"317312","type":"LOCAL"},{"code":"530452","type":"LOCAL"}],"standard_charges":[{"gross_charge":11453.05,"discounted_cash":4008.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 317312 = Hospital System Supply Identifier | 530452 = Lawson ID"}]},{"description":"IMP KNEE COLR TRAB 17-19","code_information":[{"code":"Sx00-5852-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322888","type":"LOCAL"},{"code":"536104","type":"LOCAL"}],"standard_charges":[{"gross_charge":11453.05,"discounted_cash":4008.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322888 = Hospital System Supply Identifier | 536104 = Lawson ID"}]},{"description":"IMP KNEE TOT STEM COLLAR 30MM","code_information":[{"code":"Sx00-5852-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"317085","type":"LOCAL"},{"code":"511241","type":"LOCAL"}],"standard_charges":[{"gross_charge":11453.05,"discounted_cash":4008.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 317085 = Hospital System Supply Identifier | 511241 = Lawson ID"}]},{"description":"IMP KNEE COLR SMTH 9-16","code_information":[{"code":"Sx00-5852-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322889","type":"LOCAL"},{"code":"536105","type":"LOCAL"}],"standard_charges":[{"gross_charge":11453.05,"discounted_cash":4008.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322889 = Hospital System Supply Identifier | 536105 = Lawson ID"}]},{"description":"IMP KNEE COLR SMTH 17-19","code_information":[{"code":"Sx00-5852-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322890","type":"LOCAL"},{"code":"536106","type":"LOCAL"}],"standard_charges":[{"gross_charge":11453.05,"discounted_cash":4008.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322890 = Hospital System Supply Identifier | 536106 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 14X130","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322894","type":"LOCAL"},{"code":"536110","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322894 = Hospital System Supply Identifier | 536110 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM 12X130MM","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325538","type":"LOCAL"},{"code":"353713","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325538 = Hospital System Supply Identifier | 353713 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM 9X130MM","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"316921","type":"LOCAL"},{"code":"378334","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 316921 = Hospital System Supply Identifier | 378334 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM 17X130MM","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"317086","type":"LOCAL"},{"code":"511242","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 317086 = Hospital System Supply Identifier | 511242 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 10X130","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322891","type":"LOCAL"},{"code":"536107","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322891 = Hospital System Supply Identifier | 536107 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 11X130","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322892","type":"LOCAL"},{"code":"536108","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322892 = Hospital System Supply Identifier | 536108 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 13X130","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322893","type":"LOCAL"},{"code":"536109","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322893 = Hospital System Supply Identifier | 536109 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 15X130","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322895","type":"LOCAL"},{"code":"536111","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322895 = Hospital System Supply Identifier | 536111 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 16X130","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322896","type":"LOCAL"},{"code":"536112","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322896 = Hospital System Supply Identifier | 536112 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 18X130","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322897","type":"LOCAL"},{"code":"536113","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322897 = Hospital System Supply Identifier | 536113 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 19X130","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322898","type":"LOCAL"},{"code":"536114","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322898 = Hospital System Supply Identifier | 536114 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 17X190","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322906","type":"LOCAL"},{"code":"536122","type":"LOCAL"}],"standard_charges":[{"gross_charge":17945.55,"discounted_cash":6280.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322906 = Hospital System Supply Identifier | 536122 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 16X190","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322905","type":"LOCAL"},{"code":"536121","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322905 = Hospital System Supply Identifier | 536121 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 19X190","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322908","type":"LOCAL"},{"code":"536124","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322908 = Hospital System Supply Identifier | 536124 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 18X190","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322907","type":"LOCAL"},{"code":"536123","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322907 = Hospital System Supply Identifier | 536123 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 15X190","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322904","type":"LOCAL"},{"code":"536120","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322904 = Hospital System Supply Identifier | 536120 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 9X190","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322899","type":"LOCAL"},{"code":"536115","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322899 = Hospital System Supply Identifier | 536115 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 13X190","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322902","type":"LOCAL"},{"code":"536118","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322902 = Hospital System Supply Identifier | 536118 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 11X190","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322901","type":"LOCAL"},{"code":"536117","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322901 = Hospital System Supply Identifier | 536117 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 10X190","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322900","type":"LOCAL"},{"code":"536116","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322900 = Hospital System Supply Identifier | 536116 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 14X190","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322903","type":"LOCAL"},{"code":"536119","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322903 = Hospital System Supply Identifier | 536119 = Lawson ID"}]},{"description":"IMP KNEE STEM EXT 12X190MM","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325126","type":"LOCAL"},{"code":"337484","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325126 = Hospital System Supply Identifier | 337484 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT BOW 19X250","code_information":[{"code":"Sx00-5852-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322916","type":"LOCAL"},{"code":"536132","type":"LOCAL"}],"standard_charges":[{"gross_charge":17280.9,"discounted_cash":6048.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322916 = Hospital System Supply Identifier | 536132 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT BOW 18X250","code_information":[{"code":"Sx00-5852-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322915","type":"LOCAL"},{"code":"536131","type":"LOCAL"}],"standard_charges":[{"gross_charge":17280.9,"discounted_cash":6048.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322915 = Hospital System Supply Identifier | 536131 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT BOW 17X250","code_information":[{"code":"Sx00-5852-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322914","type":"LOCAL"},{"code":"536130","type":"LOCAL"}],"standard_charges":[{"gross_charge":17783.08,"discounted_cash":6224.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322914 = Hospital System Supply Identifier | 536130 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT BOW 16X250","code_information":[{"code":"Sx00-5852-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322913","type":"LOCAL"},{"code":"536129","type":"LOCAL"}],"standard_charges":[{"gross_charge":17280.9,"discounted_cash":6048.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322913 = Hospital System Supply Identifier | 536129 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT BOW 15X250","code_information":[{"code":"Sx00-5852-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322912","type":"LOCAL"},{"code":"536128","type":"LOCAL"}],"standard_charges":[{"gross_charge":17783.08,"discounted_cash":6224.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322912 = Hospital System Supply Identifier | 536128 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT BOW 14X250","code_information":[{"code":"Sx00-5852-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322911","type":"LOCAL"},{"code":"536127","type":"LOCAL"}],"standard_charges":[{"gross_charge":17783.08,"discounted_cash":6224.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322911 = Hospital System Supply Identifier | 536127 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT BOW 13X250","code_information":[{"code":"Sx00-5852-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322910","type":"LOCAL"},{"code":"536126","type":"LOCAL"}],"standard_charges":[{"gross_charge":17783.08,"discounted_cash":6224.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322910 = Hospital System Supply Identifier | 536126 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT BOW 12X250","code_information":[{"code":"Sx00-5852-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322909","type":"LOCAL"},{"code":"536125","type":"LOCAL"}],"standard_charges":[{"gross_charge":17783.08,"discounted_cash":6224.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322909 = Hospital System Supply Identifier | 536125 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM STR 18X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322925","type":"LOCAL"},{"code":"536142","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322925 = Hospital System Supply Identifier | 536142 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM STR 19X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322926","type":"LOCAL"},{"code":"536143","type":"LOCAL"}],"standard_charges":[{"gross_charge":17945.55,"discounted_cash":6280.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322926 = Hospital System Supply Identifier | 536143 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM STR 17X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322924","type":"LOCAL"},{"code":"536141","type":"LOCAL"}],"standard_charges":[{"gross_charge":17945.55,"discounted_cash":6280.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322924 = Hospital System Supply Identifier | 536141 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM STR 16X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322923","type":"LOCAL"},{"code":"536140","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322923 = Hospital System Supply Identifier | 536140 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM STR 15X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322922","type":"LOCAL"},{"code":"536139","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322922 = Hospital System Supply Identifier | 536139 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM STR 9X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322917","type":"LOCAL"},{"code":"536133","type":"LOCAL"}],"standard_charges":[{"gross_charge":17945.55,"discounted_cash":6280.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322917 = Hospital System Supply Identifier | 536133 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM STR 13X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322920","type":"LOCAL"},{"code":"536137","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322920 = Hospital System Supply Identifier | 536137 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM STR 12X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322919","type":"LOCAL"},{"code":"536136","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322919 = Hospital System Supply Identifier | 536136 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM STR 11X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322918","type":"LOCAL"},{"code":"536135","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322918 = Hospital System Supply Identifier | 536135 = Lawson ID"}]},{"description":"IMP KNEE EXT FEM STEM R 10X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"317311","type":"LOCAL"},{"code":"530451","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 317311 = Hospital System Supply Identifier | 530451 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM STR 14X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322921","type":"LOCAL"},{"code":"536138","type":"LOCAL"}],"standard_charges":[{"gross_charge":18462.5,"discounted_cash":6461.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322921 = Hospital System Supply Identifier | 536138 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 16X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322934","type":"LOCAL"},{"code":"536151","type":"LOCAL"}],"standard_charges":[{"gross_charge":21050.4,"discounted_cash":7367.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322934 = Hospital System Supply Identifier | 536151 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 19X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322937","type":"LOCAL"},{"code":"536154","type":"LOCAL"}],"standard_charges":[{"gross_charge":20545.07,"discounted_cash":7190.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322937 = Hospital System Supply Identifier | 536154 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 18X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322936","type":"LOCAL"},{"code":"536153","type":"LOCAL"}],"standard_charges":[{"gross_charge":20545.07,"discounted_cash":7190.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322936 = Hospital System Supply Identifier | 536153 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 17X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322935","type":"LOCAL"},{"code":"536152","type":"LOCAL"}],"standard_charges":[{"gross_charge":21050.4,"discounted_cash":7367.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322935 = Hospital System Supply Identifier | 536152 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 14X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322932","type":"LOCAL"},{"code":"536149","type":"LOCAL"}],"standard_charges":[{"gross_charge":21050.4,"discounted_cash":7367.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322932 = Hospital System Supply Identifier | 536149 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 15X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322933","type":"LOCAL"},{"code":"536150","type":"LOCAL"}],"standard_charges":[{"gross_charge":21050.4,"discounted_cash":7367.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322933 = Hospital System Supply Identifier | 536150 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 13X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322931","type":"LOCAL"},{"code":"536148","type":"LOCAL"}],"standard_charges":[{"gross_charge":20545.07,"discounted_cash":7190.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322931 = Hospital System Supply Identifier | 536148 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 12X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322930","type":"LOCAL"},{"code":"536147","type":"LOCAL"}],"standard_charges":[{"gross_charge":21050.4,"discounted_cash":7367.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322930 = Hospital System Supply Identifier | 536147 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 11X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322929","type":"LOCAL"},{"code":"536146","type":"LOCAL"}],"standard_charges":[{"gross_charge":21050.4,"discounted_cash":7367.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322929 = Hospital System Supply Identifier | 536146 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 10X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322928","type":"LOCAL"},{"code":"536145","type":"LOCAL"}],"standard_charges":[{"gross_charge":20545.07,"discounted_cash":7190.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322928 = Hospital System Supply Identifier | 536145 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 9X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322927","type":"LOCAL"},{"code":"536144","type":"LOCAL"}],"standard_charges":[{"gross_charge":20545.07,"discounted_cash":7190.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322927 = Hospital System Supply Identifier | 536144 = Lawson ID"}]},{"description":"IMP KNEE PTELA AUG NXGN 19.5MM","code_information":[{"code":"Sx00-5876-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325145","type":"LOCAL"},{"code":"340098","type":"LOCAL"}],"standard_charges":[{"gross_charge":9804.9,"discounted_cash":3431.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325145 = Hospital System Supply Identifier | 340098 = Lawson ID"}]},{"description":"IMP KNEE PTELA AUG NXGN 22.5MM","code_information":[{"code":"Sx00-5876-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325146","type":"LOCAL"},{"code":"340099","type":"LOCAL"}],"standard_charges":[{"gross_charge":9804.9,"discounted_cash":3431.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325146 = Hospital System Supply Identifier | 340099 = Lawson ID"}]},{"description":"IMP KNEE PTELA AUG NXGN 23.0","code_information":[{"code":"Sx00-5876-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322620","type":"LOCAL"},{"code":"535834","type":"LOCAL"}],"standard_charges":[{"gross_charge":9804.9,"discounted_cash":3431.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322620 = Hospital System Supply Identifier | 535834 = Lawson ID"}]},{"description":"IMP KNEE PTELA AUG NXGN 20.0MM","code_information":[{"code":"Sx00-5876-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327306","type":"LOCAL"},{"code":"416875","type":"LOCAL"}],"standard_charges":[{"gross_charge":9804.9,"discounted_cash":3431.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 327306 = Hospital System Supply Identifier | 416875 = Lawson ID"}]},{"description":"IMP KNEE PTELA INS NXGN 2MM","code_information":[{"code":"Sx00-5878-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"149991","type":"LOCAL"},{"code":"237609","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 149991 = Hospital System Supply Identifier | 237609 = Lawson ID"}]},{"description":"IMP KNEE PTELA INS NXGN 35MM","code_information":[{"code":"Sx00-5878-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"158501","type":"LOCAL"},{"code":"314598","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 158501 = Hospital System Supply Identifier | 314598 = Lawson ID"}]},{"description":"IMP COMPONENT PATELLAR KNEE NEXGEN 00587806538 PMMA 10X38MM","code_information":[{"code":"Sx00-5878-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164498","type":"LOCAL"},{"code":"370030","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 164498 = Hospital System Supply Identifier | 370030 = Lawson ID"}]},{"description":"IMP KNEE PTELA INS NXGN 41MM","code_information":[{"code":"Sx00-5878-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303329","type":"LOCAL"},{"code":"522286","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303329 = Hospital System Supply Identifier | 522286 = Lawson ID"}]},{"description":"IMP KNEE PTELA NXGEN POR 10X29","code_information":[{"code":"Sx00-5878-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"581898","type":"LOCAL"},{"code":"676010","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 581898 = Hospital System Supply Identifier | 676010 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG FULL 10 SZ1","code_information":[{"code":"Sx00-5880-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322734","type":"LOCAL"},{"code":"535949","type":"LOCAL"}],"standard_charges":[{"gross_charge":6150.2,"discounted_cash":2152.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322734 = Hospital System Supply Identifier | 535949 = Lawson ID"}]},{"description":"IMP KNEE TIB N-MOD NXGN SZ1","code_information":[{"code":"Sx00-5880-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322733","type":"LOCAL"},{"code":"535948","type":"LOCAL"}],"standard_charges":[{"gross_charge":15589.0,"discounted_cash":5456.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322733 = Hospital System Supply Identifier | 535948 = Lawson ID"}]},{"description":"IMP KNEE TIB HNG NXGN SZ2","code_information":[{"code":"Sx00-5880-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325543","type":"LOCAL"},{"code":"354348","type":"LOCAL"}],"standard_charges":[{"gross_charge":15589.0,"discounted_cash":5456.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325543 = Hospital System Supply Identifier | 354348 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN SZ2 10MM","code_information":[{"code":"Sx00-5880-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329612","type":"LOCAL"},{"code":"353715","type":"LOCAL"}],"standard_charges":[{"gross_charge":6150.2,"discounted_cash":2152.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329612 = Hospital System Supply Identifier | 353715 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT HNG NXGN SZ","code_information":[{"code":"Sx00-5880-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325539","type":"LOCAL"},{"code":"353714","type":"LOCAL"}],"standard_charges":[{"gross_charge":15589.0,"discounted_cash":5456.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325539 = Hospital System Supply Identifier | 353714 = Lawson ID"}]},{"description":"IMP PLATE TIB STEM SZ3 46X67MM","code_information":[{"code":"Sx00-5880-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"199189","type":"LOCAL"},{"code":"446528","type":"LOCAL"}],"standard_charges":[{"gross_charge":15589.0,"discounted_cash":5456.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 199189 = Hospital System Supply Identifier | 446528 = Lawson ID"}]},{"description":"IMP KNEE TIB N-MOD NXGN SZ3","code_information":[{"code":"Sx00-5880-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322735","type":"LOCAL"},{"code":"535950","type":"LOCAL"}],"standard_charges":[{"gross_charge":15589.0,"discounted_cash":5456.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322735 = Hospital System Supply Identifier | 535950 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG FULL 10 SZ3","code_information":[{"code":"Sx00-5880-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322736","type":"LOCAL"},{"code":"535951","type":"LOCAL"}],"standard_charges":[{"gross_charge":6150.2,"discounted_cash":2152.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322736 = Hospital System Supply Identifier | 535951 = Lawson ID"}]},{"description":"IMP KNEE TIB ROT HNG SZ4","code_information":[{"code":"Sx00-5880-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322737","type":"LOCAL"},{"code":"535952","type":"LOCAL"}],"standard_charges":[{"gross_charge":15589.0,"discounted_cash":5456.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322737 = Hospital System Supply Identifier | 535952 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG FULL 10 SZ4","code_information":[{"code":"Sx00-5880-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322738","type":"LOCAL"},{"code":"535953","type":"LOCAL"}],"standard_charges":[{"gross_charge":6150.2,"discounted_cash":2152.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322738 = Hospital System Supply Identifier | 535953 = Lawson ID"}]},{"description":"IMP KNEE TIB ROT HNG SZ5","code_information":[{"code":"Sx00-5880-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322739","type":"LOCAL"},{"code":"535954","type":"LOCAL"}],"standard_charges":[{"gross_charge":15589.0,"discounted_cash":5456.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322739 = Hospital System Supply Identifier | 535954 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG FULL 10 SZ5","code_information":[{"code":"Sx00-5880-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322740","type":"LOCAL"},{"code":"535955","type":"LOCAL"}],"standard_charges":[{"gross_charge":6150.2,"discounted_cash":2152.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322740 = Hospital System Supply Identifier | 535955 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG FULL 10 SZ6","code_information":[{"code":"Sx00-5880-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322742","type":"LOCAL"},{"code":"535957","type":"LOCAL"}],"standard_charges":[{"gross_charge":6150.2,"discounted_cash":2152.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322742 = Hospital System Supply Identifier | 535957 = Lawson ID"}]},{"description":"IMP KNEE TIB ROT HNG SZ6","code_information":[{"code":"Sx00-5880-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322741","type":"LOCAL"},{"code":"535956","type":"LOCAL"}],"standard_charges":[{"gross_charge":15589.0,"discounted_cash":5456.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322741 = Hospital System Supply Identifier | 535956 = Lawson ID"}]},{"description":"IMP KNEE FEM ROT HNG NXGN B-LT","code_information":[{"code":"Sx00-5880-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322743","type":"LOCAL"},{"code":"535958","type":"LOCAL"}],"standard_charges":[{"gross_charge":30972.9,"discounted_cash":10840.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322743 = Hospital System Supply Identifier | 535958 = Lawson ID"}]},{"description":"IMP KNEE FEM ROT HNG NXGN B-RT","code_information":[{"code":"Sx00-5880-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322744","type":"LOCAL"},{"code":"535959","type":"LOCAL"}],"standard_charges":[{"gross_charge":30972.9,"discounted_cash":10840.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322744 = Hospital System Supply Identifier | 535959 = Lawson ID"}]},{"description":"IMP KNEE FEM ROT HNG NXGN C-LT","code_information":[{"code":"Sx00-5880-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322745","type":"LOCAL"},{"code":"535960","type":"LOCAL"}],"standard_charges":[{"gross_charge":30972.9,"discounted_cash":10840.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322745 = Hospital System Supply Identifier | 535960 = Lawson ID"}]},{"description":"IMP KNEE FEM ROT HNG NXGN C-RT","code_information":[{"code":"Sx00-5880-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322746","type":"LOCAL"},{"code":"535961","type":"LOCAL"}],"standard_charges":[{"gross_charge":30972.9,"discounted_cash":10840.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322746 = Hospital System Supply Identifier | 535961 = Lawson ID"}]},{"description":"IMP ROTATING HINGE FEM","code_information":[{"code":"Sx00-5880-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"317061","type":"LOCAL"},{"code":"446529","type":"LOCAL"}],"standard_charges":[{"gross_charge":30972.9,"discounted_cash":10840.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 317061 = Hospital System Supply Identifier | 446529 = Lawson ID"}]},{"description":"IMP HINGE FEM ROTG SZ-D LT","code_information":[{"code":"Sx00-5880-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"199312","type":"LOCAL"},{"code":"446834","type":"LOCAL"}],"standard_charges":[{"gross_charge":30972.9,"discounted_cash":10840.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 199312 = Hospital System Supply Identifier | 446834 = Lawson ID"}]},{"description":"IMP KNEE FEM ROT HNG NXGN E-LT","code_information":[{"code":"Sx00-5880-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322747","type":"LOCAL"},{"code":"535962","type":"LOCAL"}],"standard_charges":[{"gross_charge":30972.9,"discounted_cash":10840.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322747 = Hospital System Supply Identifier | 535962 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP HNG NXGN SZE","code_information":[{"code":"Sx00-5880-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325544","type":"LOCAL"},{"code":"354349","type":"LOCAL"}],"standard_charges":[{"gross_charge":30972.9,"discounted_cash":10840.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325544 = Hospital System Supply Identifier | 354349 = Lawson ID"}]},{"description":"IMP KNEE FEM ROT HNG NXGN F-LT","code_information":[{"code":"Sx00-5880-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322748","type":"LOCAL"},{"code":"535963","type":"LOCAL"}],"standard_charges":[{"gross_charge":30972.9,"discounted_cash":10840.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322748 = Hospital System Supply Identifier | 535963 = Lawson ID"}]},{"description":"IMP KNEE FEM ROT HNG NXGN F-RT","code_information":[{"code":"Sx00-5880-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322749","type":"LOCAL"},{"code":"535964","type":"LOCAL"}],"standard_charges":[{"gross_charge":30972.9,"discounted_cash":10840.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322749 = Hospital System Supply Identifier | 535964 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG B12","code_information":[{"code":"Sx00-5880-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322750","type":"LOCAL"},{"code":"535965","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322750 = Hospital System Supply Identifier | 535965 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG B14","code_information":[{"code":"Sx00-5880-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322751","type":"LOCAL"},{"code":"535966","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322751 = Hospital System Supply Identifier | 535966 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG B17","code_information":[{"code":"Sx00-5880-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322752","type":"LOCAL"},{"code":"535967","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322752 = Hospital System Supply Identifier | 535967 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG B20","code_information":[{"code":"Sx00-5880-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322753","type":"LOCAL"},{"code":"535968","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322753 = Hospital System Supply Identifier | 535968 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG B23","code_information":[{"code":"Sx00-5880-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322754","type":"LOCAL"},{"code":"535969","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322754 = Hospital System Supply Identifier | 535969 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG B26","code_information":[{"code":"Sx00-5880-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322755","type":"LOCAL"},{"code":"535970","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322755 = Hospital System Supply Identifier | 535970 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG FULL NXGN SZ2","code_information":[{"code":"Sx00-5880-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322756","type":"LOCAL"},{"code":"535971","type":"LOCAL"}],"standard_charges":[{"gross_charge":15098.12,"discounted_cash":5284.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322756 = Hospital System Supply Identifier | 535971 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG FULL NXGN SZ3","code_information":[{"code":"Sx00-5880-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322757","type":"LOCAL"},{"code":"535972","type":"LOCAL"}],"standard_charges":[{"gross_charge":15098.12,"discounted_cash":5284.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322757 = Hospital System Supply Identifier | 535972 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG FULL NXGN SZ4","code_information":[{"code":"Sx00-5880-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322758","type":"LOCAL"},{"code":"535973","type":"LOCAL"}],"standard_charges":[{"gross_charge":15098.12,"discounted_cash":5284.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322758 = Hospital System Supply Identifier | 535973 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG FULL NXGN SZ5","code_information":[{"code":"Sx00-5880-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322759","type":"LOCAL"},{"code":"535974","type":"LOCAL"}],"standard_charges":[{"gross_charge":15098.12,"discounted_cash":5284.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322759 = Hospital System Supply Identifier | 535974 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG FULL NXGN SZ6","code_information":[{"code":"Sx00-5880-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322760","type":"LOCAL"},{"code":"535975","type":"LOCAL"}],"standard_charges":[{"gross_charge":15098.12,"discounted_cash":5284.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322760 = Hospital System Supply Identifier | 535975 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG C26","code_information":[{"code":"Sx00-5880-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322766","type":"LOCAL"},{"code":"535981","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322766 = Hospital System Supply Identifier | 535981 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG C23","code_information":[{"code":"Sx00-5880-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322765","type":"LOCAL"},{"code":"535980","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322765 = Hospital System Supply Identifier | 535980 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG C20","code_information":[{"code":"Sx00-5880-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322764","type":"LOCAL"},{"code":"535979","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322764 = Hospital System Supply Identifier | 535979 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG C17","code_information":[{"code":"Sx00-5880-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322763","type":"LOCAL"},{"code":"535978","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322763 = Hospital System Supply Identifier | 535978 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG C14","code_information":[{"code":"Sx00-5880-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322762","type":"LOCAL"},{"code":"535977","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322762 = Hospital System Supply Identifier | 535977 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG C12","code_information":[{"code":"Sx00-5880-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322761","type":"LOCAL"},{"code":"535976","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322761 = Hospital System Supply Identifier | 535976 = Lawson ID"}]},{"description":"IMP TIB INS NXGN HNG SZ3 12MM","code_information":[{"code":"Sx00-5880-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194016","type":"LOCAL"},{"code":"324130","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194016 = Hospital System Supply Identifier | 324130 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG D14","code_information":[{"code":"Sx00-5880-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322767","type":"LOCAL"},{"code":"535982","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322767 = Hospital System Supply Identifier | 535982 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG D17","code_information":[{"code":"Sx00-5880-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322768","type":"LOCAL"},{"code":"535983","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322768 = Hospital System Supply Identifier | 535983 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG D20","code_information":[{"code":"Sx00-5880-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322769","type":"LOCAL"},{"code":"535984","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322769 = Hospital System Supply Identifier | 535984 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG D23","code_information":[{"code":"Sx00-5880-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322770","type":"LOCAL"},{"code":"535985","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322770 = Hospital System Supply Identifier | 535985 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG D26","code_information":[{"code":"Sx00-5880-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322771","type":"LOCAL"},{"code":"535986","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322771 = Hospital System Supply Identifier | 535986 = Lawson ID"}]},{"description":"IMP KNEE TIB INS HNG SZ4 17MM","code_information":[{"code":"Sx00-5880-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325545","type":"LOCAL"},{"code":"354350","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325545 = Hospital System Supply Identifier | 354350 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG E12","code_information":[{"code":"Sx00-5880-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322772","type":"LOCAL"},{"code":"535987","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322772 = Hospital System Supply Identifier | 535987 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG E14","code_information":[{"code":"Sx00-5880-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322773","type":"LOCAL"},{"code":"535988","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322773 = Hospital System Supply Identifier | 535988 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG E20","code_information":[{"code":"Sx00-5880-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322774","type":"LOCAL"},{"code":"535989","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322774 = Hospital System Supply Identifier | 535989 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG E23","code_information":[{"code":"Sx00-5880-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322775","type":"LOCAL"},{"code":"535990","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322775 = Hospital System Supply Identifier | 535990 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG E26","code_information":[{"code":"Sx00-5880-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322776","type":"LOCAL"},{"code":"535991","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322776 = Hospital System Supply Identifier | 535991 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG F20","code_information":[{"code":"Sx00-5880-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322780","type":"LOCAL"},{"code":"535995","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322780 = Hospital System Supply Identifier | 535995 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG F17","code_information":[{"code":"Sx00-5880-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322779","type":"LOCAL"},{"code":"535994","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322779 = Hospital System Supply Identifier | 535994 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG F23","code_information":[{"code":"Sx00-5880-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322781","type":"LOCAL"},{"code":"535996","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322781 = Hospital System Supply Identifier | 535996 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG F12","code_information":[{"code":"Sx00-5880-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322777","type":"LOCAL"},{"code":"535992","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322777 = Hospital System Supply Identifier | 535992 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG F14","code_information":[{"code":"Sx00-5880-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322778","type":"LOCAL"},{"code":"535993","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322778 = Hospital System Supply Identifier | 535993 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG F26","code_information":[{"code":"Sx00-5880-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322782","type":"LOCAL"},{"code":"535997","type":"LOCAL"}],"standard_charges":[{"gross_charge":7339.5,"discounted_cash":2568.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322782 = Hospital System Supply Identifier | 535997 = Lawson ID"}]},{"description":"IMP KNEE FEM HNG ROT SVC SZE","code_information":[{"code":"Sx00-5880-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322786","type":"LOCAL"},{"code":"536001","type":"LOCAL"}],"standard_charges":[{"gross_charge":5370.75,"discounted_cash":1879.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322786 = Hospital System Supply Identifier | 536001 = Lawson ID"}]},{"description":"IMP KNEE FEM HNG ROT SVC SZD","code_information":[{"code":"Sx00-5880-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322785","type":"LOCAL"},{"code":"536000","type":"LOCAL"}],"standard_charges":[{"gross_charge":5370.75,"discounted_cash":1879.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322785 = Hospital System Supply Identifier | 536000 = Lawson ID"}]},{"description":"IMP KNEE FEM HNG ROT SVC SZF","code_information":[{"code":"Sx00-5880-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322787","type":"LOCAL"},{"code":"536002","type":"LOCAL"}],"standard_charges":[{"gross_charge":5370.75,"discounted_cash":1879.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322787 = Hospital System Supply Identifier | 536002 = Lawson ID"}]},{"description":"COMPONENT FEMORAL KNEE CEMENTED ROTATING HINGE SIZE NEXGEN 00588009012","code_information":[{"code":"Sx00-5880-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1555839","type":"LOCAL"},{"code":"1108723","type":"LOCAL"}],"standard_charges":[{"gross_charge":3158.4,"discounted_cash":1105.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1555839 = Hospital System Supply Identifier | 1108723 = Lawson ID"}]},{"description":"COMPONENT FEMORAL KNEE CEMENTED ROTATING HINGE SIZE NEXGEN 00588009013","code_information":[{"code":"Sx00-5880-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1555848","type":"LOCAL"},{"code":"1108807","type":"LOCAL"}],"standard_charges":[{"gross_charge":5370.75,"discounted_cash":1879.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1555848 = Hospital System Supply Identifier | 1108807 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ3 17","code_information":[{"code":"Sx00-5886-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303332","type":"LOCAL"},{"code":"522289","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303332 = Hospital System Supply Identifier | 522289 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ3 14","code_information":[{"code":"Sx00-5886-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303331","type":"LOCAL"},{"code":"522288","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303331 = Hospital System Supply Identifier | 522288 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ3 10MM","code_information":[{"code":"Sx00-5886-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"162155","type":"LOCAL"},{"code":"360371","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 162155 = Hospital System Supply Identifier | 360371 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ3 12","code_information":[{"code":"Sx00-5886-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303330","type":"LOCAL"},{"code":"522287","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303330 = Hospital System Supply Identifier | 522287 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ14","code_information":[{"code":"Sx00-5886-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"149986","type":"LOCAL"},{"code":"237604","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 149986 = Hospital System Supply Identifier | 237604 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP TRABEC SZ4","code_information":[{"code":"Sx00-5886-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324186","type":"LOCAL"},{"code":"248929","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 324186 = Hospital System Supply Identifier | 248929 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ4 17MM","code_information":[{"code":"Sx00-5886-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"161395","type":"LOCAL"},{"code":"357147","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 161395 = Hospital System Supply Identifier | 357147 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ4 14","code_information":[{"code":"Sx00-5886-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303333","type":"LOCAL"},{"code":"522290","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303333 = Hospital System Supply Identifier | 522290 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ5 12","code_information":[{"code":"Sx00-5886-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"149987","type":"LOCAL"},{"code":"237605","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 149987 = Hospital System Supply Identifier | 237605 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ5 10","code_information":[{"code":"Sx00-5886-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303334","type":"LOCAL"},{"code":"522291","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303334 = Hospital System Supply Identifier | 522291 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ5 14","code_information":[{"code":"Sx00-5886-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303335","type":"LOCAL"},{"code":"522292","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303335 = Hospital System Supply Identifier | 522292 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ5 17","code_information":[{"code":"Sx00-5886-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303336","type":"LOCAL"},{"code":"522293","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303336 = Hospital System Supply Identifier | 522293 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ6 17","code_information":[{"code":"Sx00-5886-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303338","type":"LOCAL"},{"code":"522295","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303338 = Hospital System Supply Identifier | 522295 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ6 12","code_information":[{"code":"Sx00-5886-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303337","type":"LOCAL"},{"code":"522294","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303337 = Hospital System Supply Identifier | 522294 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ6 10MM","code_information":[{"code":"Sx00-5886-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"158500","type":"LOCAL"},{"code":"314597","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 158500 = Hospital System Supply Identifier | 314597 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ6 14","code_information":[{"code":"Sx00-5886-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325642","type":"LOCAL"},{"code":"360606","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325642 = Hospital System Supply Identifier | 360606 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ7 12","code_information":[{"code":"Sx00-5886-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325643","type":"LOCAL"},{"code":"360607","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325643 = Hospital System Supply Identifier | 360607 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ7 10","code_information":[{"code":"Sx00-5886-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303339","type":"LOCAL"},{"code":"522296","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303339 = Hospital System Supply Identifier | 522296 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ7 14","code_information":[{"code":"Sx00-5886-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303340","type":"LOCAL"},{"code":"522297","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303340 = Hospital System Supply Identifier | 522297 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ7 17","code_information":[{"code":"Sx00-5886-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303341","type":"LOCAL"},{"code":"522298","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303341 = Hospital System Supply Identifier | 522298 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ8 17","code_information":[{"code":"Sx00-5886-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303344","type":"LOCAL"},{"code":"522301","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303344 = Hospital System Supply Identifier | 522301 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ8 14","code_information":[{"code":"Sx00-5886-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303343","type":"LOCAL"},{"code":"522300","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303343 = Hospital System Supply Identifier | 522300 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ8 10","code_information":[{"code":"Sx00-5886-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164497","type":"LOCAL"},{"code":"370029","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 164497 = Hospital System Supply Identifier | 370029 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ8 12","code_information":[{"code":"Sx00-5886-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303342","type":"LOCAL"},{"code":"522299","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303342 = Hospital System Supply Identifier | 522299 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ3 C/D 10","code_information":[{"code":"Sx00-5886-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303345","type":"LOCAL"},{"code":"522302","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303345 = Hospital System Supply Identifier | 522302 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ3 C/D 12","code_information":[{"code":"Sx00-5886-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303346","type":"LOCAL"},{"code":"522303","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303346 = Hospital System Supply Identifier | 522303 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ3 C/D 14","code_information":[{"code":"Sx00-5886-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303347","type":"LOCAL"},{"code":"522304","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303347 = Hospital System Supply Identifier | 522304 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ3 C/D 17","code_information":[{"code":"Sx00-5886-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303348","type":"LOCAL"},{"code":"522305","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303348 = Hospital System Supply Identifier | 522305 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ4 C/D 10","code_information":[{"code":"Sx00-5886-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303349","type":"LOCAL"},{"code":"522306","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303349 = Hospital System Supply Identifier | 522306 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ4 C/D 12","code_information":[{"code":"Sx00-5886-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303350","type":"LOCAL"},{"code":"522307","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303350 = Hospital System Supply Identifier | 522307 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ4 C/D 14","code_information":[{"code":"Sx00-5886-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303351","type":"LOCAL"},{"code":"522308","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303351 = Hospital System Supply Identifier | 522308 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ4 C/D 17","code_information":[{"code":"Sx00-5886-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303352","type":"LOCAL"},{"code":"522309","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303352 = Hospital System Supply Identifier | 522309 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ5 14","code_information":[{"code":"Sx00-5886-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"163384","type":"LOCAL"},{"code":"364407","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 163384 = Hospital System Supply Identifier | 364407 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ5 E/F 10","code_information":[{"code":"Sx00-5886-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303353","type":"LOCAL"},{"code":"522310","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303353 = Hospital System Supply Identifier | 522310 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ5 E/F 12","code_information":[{"code":"Sx00-5886-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303354","type":"LOCAL"},{"code":"522311","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303354 = Hospital System Supply Identifier | 522311 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ5 E/F 17","code_information":[{"code":"Sx00-5886-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303355","type":"LOCAL"},{"code":"522312","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303355 = Hospital System Supply Identifier | 522312 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ6 E/F 17","code_information":[{"code":"Sx00-5886-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303359","type":"LOCAL"},{"code":"522316","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303359 = Hospital System Supply Identifier | 522316 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ6 E/F 14","code_information":[{"code":"Sx00-5886-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303358","type":"LOCAL"},{"code":"522315","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303358 = Hospital System Supply Identifier | 522315 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ6 E/F 12","code_information":[{"code":"Sx00-5886-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303357","type":"LOCAL"},{"code":"522314","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303357 = Hospital System Supply Identifier | 522314 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ6 E/F 10","code_information":[{"code":"Sx00-5886-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303356","type":"LOCAL"},{"code":"522313","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303356 = Hospital System Supply Identifier | 522313 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ7 G/H 10","code_information":[{"code":"Sx00-5886-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303360","type":"LOCAL"},{"code":"522317","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303360 = Hospital System Supply Identifier | 522317 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ7 G/H 12","code_information":[{"code":"Sx00-5886-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303361","type":"LOCAL"},{"code":"522318","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303361 = Hospital System Supply Identifier | 522318 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ7 G/H 14","code_information":[{"code":"Sx00-5886-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303362","type":"LOCAL"},{"code":"522319","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303362 = Hospital System Supply Identifier | 522319 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ7 G/H 17","code_information":[{"code":"Sx00-5886-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303363","type":"LOCAL"},{"code":"522320","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303363 = Hospital System Supply Identifier | 522320 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ8 G/H 10","code_information":[{"code":"Sx00-5886-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303364","type":"LOCAL"},{"code":"522321","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303364 = Hospital System Supply Identifier | 522321 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ8 G/H 12","code_information":[{"code":"Sx00-5886-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303365","type":"LOCAL"},{"code":"522322","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303365 = Hospital System Supply Identifier | 522322 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ8 G/H 14","code_information":[{"code":"Sx00-5886-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303366","type":"LOCAL"},{"code":"522323","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303366 = Hospital System Supply Identifier | 522323 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ8 G/H 17","code_information":[{"code":"Sx00-5886-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303367","type":"LOCAL"},{"code":"522324","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303367 = Hospital System Supply Identifier | 522324 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ3 E/F 10","code_information":[{"code":"Sx00-5886-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303368","type":"LOCAL"},{"code":"522325","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303368 = Hospital System Supply Identifier | 522325 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ3 E/F 12","code_information":[{"code":"Sx00-5886-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303369","type":"LOCAL"},{"code":"522326","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303369 = Hospital System Supply Identifier | 522326 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ3 E/F 14","code_information":[{"code":"Sx00-5886-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303370","type":"LOCAL"},{"code":"522327","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303370 = Hospital System Supply Identifier | 522327 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ3 E/F 17","code_information":[{"code":"Sx00-5886-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303371","type":"LOCAL"},{"code":"522328","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303371 = Hospital System Supply Identifier | 522328 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ4 E/F 14","code_information":[{"code":"Sx00-5886-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303374","type":"LOCAL"},{"code":"522331","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303374 = Hospital System Supply Identifier | 522331 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ4 E/F 17","code_information":[{"code":"Sx00-5886-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303375","type":"LOCAL"},{"code":"522332","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303375 = Hospital System Supply Identifier | 522332 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ4 E/F 10","code_information":[{"code":"Sx00-5886-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303372","type":"LOCAL"},{"code":"522329","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303372 = Hospital System Supply Identifier | 522329 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ4 E/F 12","code_information":[{"code":"Sx00-5886-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303373","type":"LOCAL"},{"code":"522330","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303373 = Hospital System Supply Identifier | 522330 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ5 G/H 10","code_information":[{"code":"Sx00-5886-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303376","type":"LOCAL"},{"code":"522333","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303376 = Hospital System Supply Identifier | 522333 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ5 G/H 12","code_information":[{"code":"Sx00-5886-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303377","type":"LOCAL"},{"code":"522334","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303377 = Hospital System Supply Identifier | 522334 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ5 G/H 14","code_information":[{"code":"Sx00-5886-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303378","type":"LOCAL"},{"code":"522335","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303378 = Hospital System Supply Identifier | 522335 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ5 G/H 17","code_information":[{"code":"Sx00-5886-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303379","type":"LOCAL"},{"code":"522336","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303379 = Hospital System Supply Identifier | 522336 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ6 G/H 17","code_information":[{"code":"Sx00-5886-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303383","type":"LOCAL"},{"code":"522340","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303383 = Hospital System Supply Identifier | 522340 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ6 G/H 14","code_information":[{"code":"Sx00-5886-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303382","type":"LOCAL"},{"code":"522339","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303382 = Hospital System Supply Identifier | 522339 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ6 G/H 10","code_information":[{"code":"Sx00-5886-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303380","type":"LOCAL"},{"code":"522337","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303380 = Hospital System Supply Identifier | 522337 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ6 G/H 12","code_information":[{"code":"Sx00-5886-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303381","type":"LOCAL"},{"code":"522338","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303381 = Hospital System Supply Identifier | 522338 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ7 E/F 10","code_information":[{"code":"Sx00-5886-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303384","type":"LOCAL"},{"code":"522341","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303384 = Hospital System Supply Identifier | 522341 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ7 E/F 12","code_information":[{"code":"Sx00-5886-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303385","type":"LOCAL"},{"code":"522342","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303385 = Hospital System Supply Identifier | 522342 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ7 E/F 14","code_information":[{"code":"Sx00-5886-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303386","type":"LOCAL"},{"code":"522343","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303386 = Hospital System Supply Identifier | 522343 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ7 E/F 17","code_information":[{"code":"Sx00-5886-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303387","type":"LOCAL"},{"code":"522344","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303387 = Hospital System Supply Identifier | 522344 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ5 C/D 14","code_information":[{"code":"Sx00-5886-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303390","type":"LOCAL"},{"code":"522347","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303390 = Hospital System Supply Identifier | 522347 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ5 C/D 10","code_information":[{"code":"Sx00-5886-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303388","type":"LOCAL"},{"code":"522345","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303388 = Hospital System Supply Identifier | 522345 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ5 C/D 12","code_information":[{"code":"Sx00-5886-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303389","type":"LOCAL"},{"code":"522346","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303389 = Hospital System Supply Identifier | 522346 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ5 C/D 17","code_information":[{"code":"Sx00-5886-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303391","type":"LOCAL"},{"code":"522348","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303391 = Hospital System Supply Identifier | 522348 = Lawson ID"}]},{"description":"HEAD FEMORAL IMPACTOR KNEE PERSONA","code_information":[{"code":"Sx00-5901-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1096772","type":"LOCAL"},{"code":"S651631","type":"LOCAL"}],"standard_charges":[{"gross_charge":1368.67,"discounted_cash":479.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1096772 = Hospital System Supply Identifier | S651631 = Lawson ID"}]},{"description":"GUIDE SCREW HEAD HEX 3.2X33MM","code_information":[{"code":"Sx00-5901-035","type":"CDM"},{"code":"272","type":"RC"},{"code":"197206","type":"LOCAL"},{"code":"438096","type":"LOCAL"}],"standard_charges":[{"gross_charge":429.25,"discounted_cash":150.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 197206 = Hospital System Supply Identifier | 438096 = Lawson ID"}]},{"description":"SCREW HEX HD 3.5X27MM","code_information":[{"code":"Sx00-5901-035","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019421","type":"LOCAL"},{"code":"869369","type":"LOCAL"}],"standard_charges":[{"gross_charge":424.2,"discounted_cash":148.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1019421 = Hospital System Supply Identifier | 869369 = Lawson ID"}]},{"description":"SCREW HEX HD 3.5X48MM","code_information":[{"code":"Sx00-5901-035","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019422","type":"LOCAL"},{"code":"869370","type":"LOCAL"}],"standard_charges":[{"gross_charge":671.65,"discounted_cash":235.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1019422 = Hospital System Supply Identifier | 869370 = Lawson ID"}]},{"description":"ROD EXTERNAL FIXATION TELESCOPE CUT GUIDE PERSONA","code_information":[{"code":"Sx00-5907-080","type":"CDM"},{"code":"272","type":"RC"},{"code":"1102294","type":"LOCAL"},{"code":"S657293","type":"LOCAL"}],"standard_charges":[{"gross_charge":2800.87,"discounted_cash":980.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1102294 = Hospital System Supply Identifier | S657293 = Lawson ID"}]},{"description":"ROD EXTERNAL FIXATION DISTAL EXTRAMEDULLARY PERSONA","code_information":[{"code":"Sx00-5907-080","type":"CDM"},{"code":"272","type":"RC"},{"code":"1102280","type":"LOCAL"},{"code":"S657296","type":"LOCAL"}],"standard_charges":[{"gross_charge":507.5,"discounted_cash":177.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1102280 = Hospital System Supply Identifier | S657296 = Lawson ID"}]},{"description":"SPACER FEMORAL STANDARD 10MM BLOCK MIS PERSONA","code_information":[{"code":"Sx00-5907-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1104821","type":"LOCAL"},{"code":"S652535","type":"LOCAL"}],"standard_charges":[{"gross_charge":560.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1104821 = Hospital System Supply Identifier | S652535 = Lawson ID"}]},{"description":"SPACER FEMORAL STANDARD 14MM BLOCK MIS PERSONA","code_information":[{"code":"Sx00-5907-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1104823","type":"LOCAL"},{"code":"S652536","type":"LOCAL"}],"standard_charges":[{"gross_charge":560.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1104823 = Hospital System Supply Identifier | S652536 = Lawson ID"}]},{"description":"SPACER FEMORAL STANDARD 12IN BLOCK MIS","code_information":[{"code":"Sx00-5907-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1104822","type":"LOCAL"},{"code":"S652537","type":"LOCAL"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1104822 = Hospital System Supply Identifier | S652537 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ1","code_information":[{"code":"Sx00-5916-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303397","type":"LOCAL"},{"code":"522354","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303397 = Hospital System Supply Identifier | 522354 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ2","code_information":[{"code":"Sx00-5916-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303399","type":"LOCAL"},{"code":"522356","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303399 = Hospital System Supply Identifier | 522356 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC AB/123 10MM","code_information":[{"code":"Sx00-5916-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303400","type":"LOCAL"},{"code":"522357","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303400 = Hospital System Supply Identifier | 522357 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC AB/123 12MM","code_information":[{"code":"Sx00-5916-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303401","type":"LOCAL"},{"code":"522358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303401 = Hospital System Supply Identifier | 522358 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC AB/123 14MM","code_information":[{"code":"Sx00-5916-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303402","type":"LOCAL"},{"code":"522359","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303402 = Hospital System Supply Identifier | 522359 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC AB/123 17MM","code_information":[{"code":"Sx00-5916-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303403","type":"LOCAL"},{"code":"522360","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303403 = Hospital System Supply Identifier | 522360 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC AB/123 20MM","code_information":[{"code":"Sx00-5916-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303404","type":"LOCAL"},{"code":"522361","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303404 = Hospital System Supply Identifier | 522361 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC C/234 20MM","code_information":[{"code":"Sx00-5916-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303410","type":"LOCAL"},{"code":"522367","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303410 = Hospital System Supply Identifier | 522367 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC C/234 17MM","code_information":[{"code":"Sx00-5916-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303409","type":"LOCAL"},{"code":"522366","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303409 = Hospital System Supply Identifier | 522366 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC C/234 14MM","code_information":[{"code":"Sx00-5916-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303408","type":"LOCAL"},{"code":"522365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303408 = Hospital System Supply Identifier | 522365 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC C/234 12MM","code_information":[{"code":"Sx00-5916-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303407","type":"LOCAL"},{"code":"522364","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303407 = Hospital System Supply Identifier | 522364 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC C/23410MM","code_information":[{"code":"Sx00-5916-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303406","type":"LOCAL"},{"code":"522363","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303406 = Hospital System Supply Identifier | 522363 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ3","code_information":[{"code":"Sx00-5916-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303405","type":"LOCAL"},{"code":"522362","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303405 = Hospital System Supply Identifier | 522362 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-5 10MM","code_information":[{"code":"Sx00-5916-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329681","type":"LOCAL"},{"code":"360609","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329681 = Hospital System Supply Identifier | 360609 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ4","code_information":[{"code":"Sx00-5916-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303412","type":"LOCAL"},{"code":"522369","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303412 = Hospital System Supply Identifier | 522369 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC D/345 12MM","code_information":[{"code":"Sx00-5916-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303413","type":"LOCAL"},{"code":"522370","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303413 = Hospital System Supply Identifier | 522370 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC D/345 14MM","code_information":[{"code":"Sx00-5916-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303414","type":"LOCAL"},{"code":"522371","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303414 = Hospital System Supply Identifier | 522371 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC D/345 17MM","code_information":[{"code":"Sx00-5916-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303415","type":"LOCAL"},{"code":"522372","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303415 = Hospital System Supply Identifier | 522372 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC D/345 20MM","code_information":[{"code":"Sx00-5916-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303416","type":"LOCAL"},{"code":"522373","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303416 = Hospital System Supply Identifier | 522373 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC E/456 20MM","code_information":[{"code":"Sx00-5916-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303423","type":"LOCAL"},{"code":"522380","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303423 = Hospital System Supply Identifier | 522380 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC E/456 17MM","code_information":[{"code":"Sx00-5916-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303422","type":"LOCAL"},{"code":"522379","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303422 = Hospital System Supply Identifier | 522379 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC E/456 14MM","code_information":[{"code":"Sx00-5916-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303421","type":"LOCAL"},{"code":"522378","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303421 = Hospital System Supply Identifier | 522378 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ5","code_information":[{"code":"Sx00-5916-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303418","type":"LOCAL"},{"code":"522375","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303418 = Hospital System Supply Identifier | 522375 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC E/456 10MM","code_information":[{"code":"Sx00-5916-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303419","type":"LOCAL"},{"code":"522376","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303419 = Hospital System Supply Identifier | 522376 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC E/456 12MM","code_information":[{"code":"Sx00-5916-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303420","type":"LOCAL"},{"code":"522377","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303420 = Hospital System Supply Identifier | 522377 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC F/567 17MM","code_information":[{"code":"Sx00-5916-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303429","type":"LOCAL"},{"code":"522386","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303429 = Hospital System Supply Identifier | 522386 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC F/567 20MM","code_information":[{"code":"Sx00-5916-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303430","type":"LOCAL"},{"code":"522387","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303430 = Hospital System Supply Identifier | 522387 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC F/567 14MM","code_information":[{"code":"Sx00-5916-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303428","type":"LOCAL"},{"code":"522385","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303428 = Hospital System Supply Identifier | 522385 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC F/567 10MM","code_information":[{"code":"Sx00-5916-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303426","type":"LOCAL"},{"code":"522383","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303426 = Hospital System Supply Identifier | 522383 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ6","code_information":[{"code":"Sx00-5916-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303425","type":"LOCAL"},{"code":"522382","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303425 = Hospital System Supply Identifier | 522382 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC F/567 12MM","code_information":[{"code":"Sx00-5916-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303427","type":"LOCAL"},{"code":"522384","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303427 = Hospital System Supply Identifier | 522384 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ7","code_information":[{"code":"Sx00-5916-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303432","type":"LOCAL"},{"code":"522389","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303432 = Hospital System Supply Identifier | 522389 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G/678 10MM","code_information":[{"code":"Sx00-5916-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303433","type":"LOCAL"},{"code":"522390","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303433 = Hospital System Supply Identifier | 522390 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G/678 12MM","code_information":[{"code":"Sx00-5916-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303434","type":"LOCAL"},{"code":"522391","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303434 = Hospital System Supply Identifier | 522391 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G/678 14MM","code_information":[{"code":"Sx00-5916-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303435","type":"LOCAL"},{"code":"522392","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303435 = Hospital System Supply Identifier | 522392 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G/678 17MM","code_information":[{"code":"Sx00-5916-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303436","type":"LOCAL"},{"code":"522393","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303436 = Hospital System Supply Identifier | 522393 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G/678 20MM","code_information":[{"code":"Sx00-5916-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303437","type":"LOCAL"},{"code":"522394","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303437 = Hospital System Supply Identifier | 522394 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ8","code_information":[{"code":"Sx00-5916-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303439","type":"LOCAL"},{"code":"522396","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303439 = Hospital System Supply Identifier | 522396 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ AB/123 10","code_information":[{"code":"Sx00-5917-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303440","type":"LOCAL"},{"code":"522397","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303440 = Hospital System Supply Identifier | 522397 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ AB/123 12","code_information":[{"code":"Sx00-5917-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303441","type":"LOCAL"},{"code":"522398","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303441 = Hospital System Supply Identifier | 522398 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ AB/123 14","code_information":[{"code":"Sx00-5917-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303442","type":"LOCAL"},{"code":"522399","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303442 = Hospital System Supply Identifier | 522399 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ C/234 20MM","code_information":[{"code":"Sx00-5917-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303449","type":"LOCAL"},{"code":"522406","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303449 = Hospital System Supply Identifier | 522406 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ C/234 17MM","code_information":[{"code":"Sx00-5917-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303448","type":"LOCAL"},{"code":"522405","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303448 = Hospital System Supply Identifier | 522405 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ C/234 10MM","code_information":[{"code":"Sx00-5917-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303445","type":"LOCAL"},{"code":"522402","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303445 = Hospital System Supply Identifier | 522402 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ C/234 14MM","code_information":[{"code":"Sx00-5917-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303447","type":"LOCAL"},{"code":"522404","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303447 = Hospital System Supply Identifier | 522404 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ D/345 10MM","code_information":[{"code":"Sx00-5917-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303450","type":"LOCAL"},{"code":"522407","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303450 = Hospital System Supply Identifier | 522407 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ D/345 12MM","code_information":[{"code":"Sx00-5917-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303451","type":"LOCAL"},{"code":"522408","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303451 = Hospital System Supply Identifier | 522408 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ D/345 14MM","code_information":[{"code":"Sx00-5917-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303452","type":"LOCAL"},{"code":"522409","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303452 = Hospital System Supply Identifier | 522409 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ D/345 17MM","code_information":[{"code":"Sx00-5917-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303453","type":"LOCAL"},{"code":"522410","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303453 = Hospital System Supply Identifier | 522410 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ D/345 20MM","code_information":[{"code":"Sx00-5917-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303454","type":"LOCAL"},{"code":"522411","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303454 = Hospital System Supply Identifier | 522411 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ E/456 10MM","code_information":[{"code":"Sx00-5917-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303455","type":"LOCAL"},{"code":"522412","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303455 = Hospital System Supply Identifier | 522412 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ E/456 12MM","code_information":[{"code":"Sx00-5917-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303456","type":"LOCAL"},{"code":"522413","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303456 = Hospital System Supply Identifier | 522413 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ E/456 14MM","code_information":[{"code":"Sx00-5917-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303457","type":"LOCAL"},{"code":"522414","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303457 = Hospital System Supply Identifier | 522414 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ E/456 17MM","code_information":[{"code":"Sx00-5917-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303458","type":"LOCAL"},{"code":"522415","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303458 = Hospital System Supply Identifier | 522415 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ E/456 20MM","code_information":[{"code":"Sx00-5917-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303459","type":"LOCAL"},{"code":"522416","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303459 = Hospital System Supply Identifier | 522416 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ F/567 14MM","code_information":[{"code":"Sx00-5917-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303462","type":"LOCAL"},{"code":"522419","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303462 = Hospital System Supply Identifier | 522419 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ F/567 10MM","code_information":[{"code":"Sx00-5917-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303460","type":"LOCAL"},{"code":"522417","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303460 = Hospital System Supply Identifier | 522417 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ F/567 12MM","code_information":[{"code":"Sx00-5917-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303461","type":"LOCAL"},{"code":"522418","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303461 = Hospital System Supply Identifier | 522418 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ F/567 20MM","code_information":[{"code":"Sx00-5917-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303464","type":"LOCAL"},{"code":"522421","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303464 = Hospital System Supply Identifier | 522421 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ G/678 17MM","code_information":[{"code":"Sx00-5917-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303468","type":"LOCAL"},{"code":"522425","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303468 = Hospital System Supply Identifier | 522425 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ G/678 14MM","code_information":[{"code":"Sx00-5917-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303467","type":"LOCAL"},{"code":"522424","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303467 = Hospital System Supply Identifier | 522424 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ G/678 20MM","code_information":[{"code":"Sx00-5917-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303469","type":"LOCAL"},{"code":"522426","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303469 = Hospital System Supply Identifier | 522426 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ G/678 10MM","code_information":[{"code":"Sx00-5917-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303465","type":"LOCAL"},{"code":"522422","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303465 = Hospital System Supply Identifier | 522422 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ G/678 12MM","code_information":[{"code":"Sx00-5917-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303466","type":"LOCAL"},{"code":"522423","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303466 = Hospital System Supply Identifier | 522423 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP CEM SZ1 LT","code_information":[{"code":"Sx00-5926-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303470","type":"LOCAL"},{"code":"522427","type":"LOCAL"}],"standard_charges":[{"gross_charge":9460.0,"discounted_cash":3311.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303470 = Hospital System Supply Identifier | 522427 = Lawson ID"}]},{"description":"IMP KNEE FEM RT SZ1","code_information":[{"code":"Sx00-5926-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198353","type":"LOCAL"},{"code":"443602","type":"LOCAL"}],"standard_charges":[{"gross_charge":9460.0,"discounted_cash":3311.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 198353 = Hospital System Supply Identifier | 443602 = Lawson ID"}]},{"description":"IMP KNEE FEM NXGN RT SZ2","code_information":[{"code":"Sx00-5926-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"195908","type":"LOCAL"},{"code":"395488","type":"LOCAL"}],"standard_charges":[{"gross_charge":9460.0,"discounted_cash":3311.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 195908 = Hospital System Supply Identifier | 395488 = Lawson ID"}]},{"description":"IMP KNEE FEM NXGN LT SZ2","code_information":[{"code":"Sx00-5926-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196547","type":"LOCAL"},{"code":"412512","type":"LOCAL"}],"standard_charges":[{"gross_charge":9460.0,"discounted_cash":3311.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 196547 = Hospital System Supply Identifier | 412512 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZ3","code_information":[{"code":"Sx00-5926-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194867","type":"LOCAL"},{"code":"355204","type":"LOCAL"}],"standard_charges":[{"gross_charge":9460.0,"discounted_cash":3311.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194867 = Hospital System Supply Identifier | 355204 = Lawson ID"}]},{"description":"IMP KNEE FEM NXGN LT SZ3","code_information":[{"code":"Sx00-5926-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196548","type":"LOCAL"},{"code":"412513","type":"LOCAL"}],"standard_charges":[{"gross_charge":9460.0,"discounted_cash":3311.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 196548 = Hospital System Supply Identifier | 412513 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZ4","code_information":[{"code":"Sx00-5926-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325953","type":"LOCAL"},{"code":"373922","type":"LOCAL"}],"standard_charges":[{"gross_charge":9460.0,"discounted_cash":3311.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325953 = Hospital System Supply Identifier | 373922 = Lawson ID"}]},{"description":"IMP KNEE FEM NXGN LT SZ4","code_information":[{"code":"Sx00-5926-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327193","type":"LOCAL"},{"code":"412514","type":"LOCAL"}],"standard_charges":[{"gross_charge":9460.0,"discounted_cash":3311.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 327193 = Hospital System Supply Identifier | 412514 = Lawson ID"}]},{"description":"IMP KNEE FEM NXGN LT SZ5","code_information":[{"code":"Sx00-5926-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196549","type":"LOCAL"},{"code":"412515","type":"LOCAL"}],"standard_charges":[{"gross_charge":9460.0,"discounted_cash":3311.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 196549 = Hospital System Supply Identifier | 412515 = Lawson ID"}]},{"description":"IMP KNEE FEM NXGN RT SZ5","code_information":[{"code":"Sx00-5926-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327194","type":"LOCAL"},{"code":"412516","type":"LOCAL"}],"standard_charges":[{"gross_charge":9460.0,"discounted_cash":3311.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 327194 = Hospital System Supply Identifier | 412516 = Lawson ID"}]},{"description":"BUR MILLING STD GENDER KNEE","code_information":[{"code":"Sx00-5927-050","type":"CDM"},{"code":"272","type":"RC"},{"code":"194868","type":"LOCAL"},{"code":"355205","type":"LOCAL"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194868 = Hospital System Supply Identifier | 355205 = Lawson ID"}]},{"description":"DRILL KNEE FEM PEG/TAIL","code_information":[{"code":"Sx00-5927-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449641","type":"LOCAL"},{"code":"421389","type":"LOCAL"}],"standard_charges":[{"gross_charge":770.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 449641 = Hospital System Supply Identifier | 421389 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZC","code_information":[{"code":"Sx00-5950-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179103","type":"LOCAL"},{"code":"223282","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179103 = Hospital System Supply Identifier | 223282 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZC","code_information":[{"code":"Sx00-5950-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323419","type":"LOCAL"},{"code":"223283","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 323419 = Hospital System Supply Identifier | 223283 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZC","code_information":[{"code":"Sx00-5950-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323420","type":"LOCAL"},{"code":"223284","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 323420 = Hospital System Supply Identifier | 223284 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZC","code_information":[{"code":"Sx00-5950-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323421","type":"LOCAL"},{"code":"223285","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 323421 = Hospital System Supply Identifier | 223285 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZD","code_information":[{"code":"Sx00-5950-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146863","type":"LOCAL"},{"code":"223289","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146863 = Hospital System Supply Identifier | 223289 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZD","code_information":[{"code":"Sx00-5950-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323422","type":"LOCAL"},{"code":"223288","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 323422 = Hospital System Supply Identifier | 223288 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZD","code_information":[{"code":"Sx00-5950-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179104","type":"LOCAL"},{"code":"223286","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179104 = Hospital System Supply Identifier | 223286 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZD","code_information":[{"code":"Sx00-5950-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179105","type":"LOCAL"},{"code":"223287","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179105 = Hospital System Supply Identifier | 223287 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZE","code_information":[{"code":"Sx00-5950-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146864","type":"LOCAL"},{"code":"223290","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146864 = Hospital System Supply Identifier | 223290 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZE","code_information":[{"code":"Sx00-5950-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179106","type":"LOCAL"},{"code":"223291","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179106 = Hospital System Supply Identifier | 223291 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZE","code_information":[{"code":"Sx00-5950-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178236","type":"LOCAL"},{"code":"223292","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178236 = Hospital System Supply Identifier | 223292 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZE","code_information":[{"code":"Sx00-5950-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323423","type":"LOCAL"},{"code":"223293","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 323423 = Hospital System Supply Identifier | 223293 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZF","code_information":[{"code":"Sx00-5950-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323424","type":"LOCAL"},{"code":"223296","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 323424 = Hospital System Supply Identifier | 223296 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZF","code_information":[{"code":"Sx00-5950-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179107","type":"LOCAL"},{"code":"223294","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179107 = Hospital System Supply Identifier | 223294 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZF","code_information":[{"code":"Sx00-5950-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179108","type":"LOCAL"},{"code":"223295","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179108 = Hospital System Supply Identifier | 223295 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZF","code_information":[{"code":"Sx00-5950-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179109","type":"LOCAL"},{"code":"223297","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179109 = Hospital System Supply Identifier | 223297 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZG","code_information":[{"code":"Sx00-5950-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179110","type":"LOCAL"},{"code":"223298","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179110 = Hospital System Supply Identifier | 223298 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZG","code_information":[{"code":"Sx00-5950-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179111","type":"LOCAL"},{"code":"223299","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179111 = Hospital System Supply Identifier | 223299 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZG","code_information":[{"code":"Sx00-5950-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323425","type":"LOCAL"},{"code":"223300","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 323425 = Hospital System Supply Identifier | 223300 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZG","code_information":[{"code":"Sx00-5950-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179112","type":"LOCAL"},{"code":"223301","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179112 = Hospital System Supply Identifier | 223301 = Lawson ID"}]},{"description":"IMP STEM MIS DROP DN 45 EXT","code_information":[{"code":"Sx00-5950-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202347","type":"LOCAL"},{"code":"452446","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202347 = Hospital System Supply Identifier | 452446 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZD","code_information":[{"code":"Sx00-5952-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325560","type":"LOCAL"},{"code":"354407","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325560 = Hospital System Supply Identifier | 354407 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZD","code_information":[{"code":"Sx00-5952-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325556","type":"LOCAL"},{"code":"354403","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325556 = Hospital System Supply Identifier | 354403 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZF","code_information":[{"code":"Sx00-5952-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325557","type":"LOCAL"},{"code":"354404","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325557 = Hospital System Supply Identifier | 354404 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZF","code_information":[{"code":"Sx00-5952-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"149127","type":"LOCAL"},{"code":"236427","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 149127 = Hospital System Supply Identifier | 236427 = Lawson ID"}]},{"description":"IMP KNEE FEM INS NXGN CR F-MNS","code_information":[{"code":"Sx00-5952-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"149594","type":"LOCAL"},{"code":"237017","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 149594 = Hospital System Supply Identifier | 237017 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZG","code_information":[{"code":"Sx00-5952-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325559","type":"LOCAL"},{"code":"354406","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325559 = Hospital System Supply Identifier | 354406 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZG","code_information":[{"code":"Sx00-5952-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179211","type":"LOCAL"},{"code":"354408","type":"LOCAL"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179211 = Hospital System Supply Identifier | 354408 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN CR 10MM","code_information":[{"code":"Sx00-5952-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146885","type":"LOCAL"},{"code":"223569","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146885 = Hospital System Supply Identifier | 223569 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN CR 12MM","code_information":[{"code":"Sx00-5952-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146886","type":"LOCAL"},{"code":"223570","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146886 = Hospital System Supply Identifier | 223570 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN CR 14MM","code_information":[{"code":"Sx00-5952-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192144","type":"LOCAL"},{"code":"223571","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 192144 = Hospital System Supply Identifier | 223571 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 3-4 10MM","code_information":[{"code":"Sx00-5952-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146865","type":"LOCAL"},{"code":"223302","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146865 = Hospital System Supply Identifier | 223302 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 3-4 12MM","code_information":[{"code":"Sx00-5952-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146866","type":"LOCAL"},{"code":"223303","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146866 = Hospital System Supply Identifier | 223303 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 3-4 14MM","code_information":[{"code":"Sx00-5952-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146867","type":"LOCAL"},{"code":"223304","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146867 = Hospital System Supply Identifier | 223304 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 5-6 10MM","code_information":[{"code":"Sx00-5952-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146868","type":"LOCAL"},{"code":"223307","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146868 = Hospital System Supply Identifier | 223307 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 5-6 12MM","code_information":[{"code":"Sx00-5952-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179113","type":"LOCAL"},{"code":"223308","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179113 = Hospital System Supply Identifier | 223308 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 5-6 14MM","code_information":[{"code":"Sx00-5952-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146869","type":"LOCAL"},{"code":"223309","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146869 = Hospital System Supply Identifier | 223309 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 7-10 14MM","code_information":[{"code":"Sx00-5952-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192119","type":"LOCAL"},{"code":"223314","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 192119 = Hospital System Supply Identifier | 223314 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 7-10 12MM","code_information":[{"code":"Sx00-5952-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179114","type":"LOCAL"},{"code":"223313","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179114 = Hospital System Supply Identifier | 223313 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 7-10 10MM","code_information":[{"code":"Sx00-5952-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178238","type":"LOCAL"},{"code":"223312","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178238 = Hospital System Supply Identifier | 223312 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MOD SZ2","code_information":[{"code":"Sx00-5954-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303484","type":"LOCAL"},{"code":"522441","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303484 = Hospital System Supply Identifier | 522441 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ3","code_information":[{"code":"Sx00-5954-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327196","type":"LOCAL"},{"code":"412525","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 327196 = Hospital System Supply Identifier | 412525 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ4","code_information":[{"code":"Sx00-5954-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328270","type":"LOCAL"},{"code":"441625","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 328270 = Hospital System Supply Identifier | 441625 = Lawson ID"}]},{"description":"TIBIAL FIXED BEARING SZ 5","code_information":[{"code":"Sx00-5954-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329808","type":"LOCAL"},{"code":"379487","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329808 = Hospital System Supply Identifier | 379487 = Lawson ID"}]},{"description":"TIBIAL FIXED BEARING SZ 6","code_information":[{"code":"Sx00-5954-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179309","type":"LOCAL"},{"code":"441626","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179309 = Hospital System Supply Identifier | 441626 = Lawson ID"}]},{"description":"TIBIAL TRAY TRIBECULAR SZ 7","code_information":[{"code":"Sx00-5954-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662131","type":"LOCAL"},{"code":"376282","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662131 = Hospital System Supply Identifier | 376282 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MOD SZ8","code_information":[{"code":"Sx00-5954-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303485","type":"LOCAL"},{"code":"522442","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303485 = Hospital System Supply Identifier | 522442 = Lawson ID"}]},{"description":"SCREW FLX MIS TRAB METAL","code_information":[{"code":"Sx00-5954-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"303486","type":"LOCAL"},{"code":"522443","type":"LOCAL"}],"standard_charges":[{"gross_charge":367.5,"discounted_cash":128.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303486 = Hospital System Supply Identifier | 522443 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZA","code_information":[{"code":"Sx00-5960-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303489","type":"LOCAL"},{"code":"522446","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303489 = Hospital System Supply Identifier | 522446 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZA","code_information":[{"code":"Sx00-5960-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303490","type":"LOCAL"},{"code":"522447","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303490 = Hospital System Supply Identifier | 522447 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZB","code_information":[{"code":"Sx00-5960-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324420","type":"LOCAL"},{"code":"298188","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 324420 = Hospital System Supply Identifier | 298188 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZB","code_information":[{"code":"Sx00-5960-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324421","type":"LOCAL"},{"code":"298189","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 324421 = Hospital System Supply Identifier | 298189 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LPS-FLX SZH","code_information":[{"code":"Sx00-5960-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"171791","type":"LOCAL"},{"code":"439194","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 171791 = Hospital System Supply Identifier | 439194 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZH","code_information":[{"code":"Sx00-5960-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"170312","type":"LOCAL"},{"code":"412542","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 170312 = Hospital System Supply Identifier | 412542 = Lawson ID"}]},{"description":"PLUG TAPIER STEM","code_information":[{"code":"Sx00-5960-099","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"145669","type":"LOCAL"},{"code":"223415","type":"LOCAL"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145669 = Hospital System Supply Identifier | 223415 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL AB 1-2 20M","code_information":[{"code":"Sx00-5962-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329220","type":"LOCAL"},{"code":"298142","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329220 = Hospital System Supply Identifier | 298142 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 1-2 23","code_information":[{"code":"Sx00-5962-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449633","type":"LOCAL"},{"code":"401997","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 449633 = Hospital System Supply Identifier | 401997 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 17MM","code_information":[{"code":"Sx00-5962-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329219","type":"LOCAL"},{"code":"298141","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329219 = Hospital System Supply Identifier | 298141 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 14MM","code_information":[{"code":"Sx00-5962-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329218","type":"LOCAL"},{"code":"298140","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329218 = Hospital System Supply Identifier | 298140 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 12MM","code_information":[{"code":"Sx00-5962-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329217","type":"LOCAL"},{"code":"298139","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329217 = Hospital System Supply Identifier | 298139 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 10MM","code_information":[{"code":"Sx00-5962-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329216","type":"LOCAL"},{"code":"298138","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329216 = Hospital System Supply Identifier | 298138 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 10MM","code_information":[{"code":"Sx00-5962-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169647","type":"LOCAL"},{"code":"298143","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 169647 = Hospital System Supply Identifier | 298143 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 12MM","code_information":[{"code":"Sx00-5962-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154584","type":"LOCAL"},{"code":"298144","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154584 = Hospital System Supply Identifier | 298144 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 14MM","code_information":[{"code":"Sx00-5962-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145979","type":"LOCAL"},{"code":"298145","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145979 = Hospital System Supply Identifier | 298145 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 17MM","code_information":[{"code":"Sx00-5962-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154585","type":"LOCAL"},{"code":"298146","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154585 = Hospital System Supply Identifier | 298146 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL CD 1-2 20M","code_information":[{"code":"Sx00-5962-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193378","type":"LOCAL"},{"code":"298147","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193378 = Hospital System Supply Identifier | 298147 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN CD1-2 23","code_information":[{"code":"Sx00-5962-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196564","type":"LOCAL"},{"code":"412544","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 196564 = Hospital System Supply Identifier | 412544 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 17","code_information":[{"code":"Sx00-5962-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327307","type":"LOCAL"},{"code":"416876","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 327307 = Hospital System Supply Identifier | 416876 = Lawson ID"}]},{"description":"IMP KNEE ART SURF NXGN SZE 10","code_information":[{"code":"Sx00-5962-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"170362","type":"LOCAL"},{"code":"418244","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 170362 = Hospital System Supply Identifier | 418244 = Lawson ID"}]},{"description":"IMP KNEE ART SURF NXGN SZE 12","code_information":[{"code":"Sx00-5962-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"171771","type":"LOCAL"},{"code":"418245","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 171771 = Hospital System Supply Identifier | 418245 = Lawson ID"}]},{"description":"IMP KNEE ART SURF NXGN SZE 14","code_information":[{"code":"Sx00-5962-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"170363","type":"LOCAL"},{"code":"418246","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 170363 = Hospital System Supply Identifier | 418246 = Lawson ID"}]},{"description":"IMP KNEE SURF PROLNG E 1-2 20","code_information":[{"code":"Sx00-5962-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303552","type":"LOCAL"},{"code":"522509","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303552 = Hospital System Supply Identifier | 522509 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 3-4 23MM","code_information":[{"code":"Sx00-5962-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196565","type":"LOCAL"},{"code":"412545","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 196565 = Hospital System Supply Identifier | 412545 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-4 20MM","code_information":[{"code":"Sx00-5962-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193380","type":"LOCAL"},{"code":"298152","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193380 = Hospital System Supply Identifier | 298152 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-4 17MM","code_information":[{"code":"Sx00-5962-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193379","type":"LOCAL"},{"code":"298151","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193379 = Hospital System Supply Identifier | 298151 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-4 12MM","code_information":[{"code":"Sx00-5962-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169649","type":"LOCAL"},{"code":"298149","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 169649 = Hospital System Supply Identifier | 298149 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-4 10MM","code_information":[{"code":"Sx00-5962-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169648","type":"LOCAL"},{"code":"298148","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 169648 = Hospital System Supply Identifier | 298148 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-4 14MM","code_information":[{"code":"Sx00-5962-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154586","type":"LOCAL"},{"code":"298150","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154586 = Hospital System Supply Identifier | 298150 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 3-4 23","code_information":[{"code":"Sx00-5962-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449634","type":"LOCAL"},{"code":"401998","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 449634 = Hospital System Supply Identifier | 401998 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 10MM","code_information":[{"code":"Sx00-5962-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329221","type":"LOCAL"},{"code":"298153","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329221 = Hospital System Supply Identifier | 298153 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 12MM","code_information":[{"code":"Sx00-5962-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329222","type":"LOCAL"},{"code":"298154","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329222 = Hospital System Supply Identifier | 298154 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 14MM","code_information":[{"code":"Sx00-5962-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329223","type":"LOCAL"},{"code":"298155","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329223 = Hospital System Supply Identifier | 298155 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 17MM","code_information":[{"code":"Sx00-5962-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329224","type":"LOCAL"},{"code":"298156","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329224 = Hospital System Supply Identifier | 298156 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 20MM","code_information":[{"code":"Sx00-5962-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329225","type":"LOCAL"},{"code":"298157","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329225 = Hospital System Supply Identifier | 298157 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-4 10MM","code_information":[{"code":"Sx00-5962-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154587","type":"LOCAL"},{"code":"298158","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154587 = Hospital System Supply Identifier | 298158 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-4 12MM","code_information":[{"code":"Sx00-5962-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154588","type":"LOCAL"},{"code":"298159","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154588 = Hospital System Supply Identifier | 298159 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-4 14MM","code_information":[{"code":"Sx00-5962-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154589","type":"LOCAL"},{"code":"298160","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154589 = Hospital System Supply Identifier | 298160 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-4 17MM","code_information":[{"code":"Sx00-5962-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154590","type":"LOCAL"},{"code":"298161","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154590 = Hospital System Supply Identifier | 298161 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-4 20MM","code_information":[{"code":"Sx00-5962-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193381","type":"LOCAL"},{"code":"298162","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193381 = Hospital System Supply Identifier | 298162 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 3-4 23MM","code_information":[{"code":"Sx00-5962-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196566","type":"LOCAL"},{"code":"412546","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 196566 = Hospital System Supply Identifier | 412546 = Lawson ID"}]},{"description":"IMP KNEE SURF PROLNG G 3-4 17","code_information":[{"code":"Sx00-5962-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303554","type":"LOCAL"},{"code":"522511","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303554 = Hospital System Supply Identifier | 522511 = Lawson ID"}]},{"description":"IMP KNEE SURF PROLNG G 3-4 14","code_information":[{"code":"Sx00-5962-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303553","type":"LOCAL"},{"code":"522510","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303553 = Hospital System Supply Identifier | 522510 = Lawson ID"}]},{"description":"IMP KNEE SURF PROLNG G 3-4 20","code_information":[{"code":"Sx00-5962-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303555","type":"LOCAL"},{"code":"522512","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303555 = Hospital System Supply Identifier | 522512 = Lawson ID"}]},{"description":"IMP KNEE ART SURF NXGN SZG 10","code_information":[{"code":"Sx00-5962-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327317","type":"LOCAL"},{"code":"418247","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 327317 = Hospital System Supply Identifier | 418247 = Lawson ID"}]},{"description":"IMP KNEE ART SURF NXGN SZG 12","code_information":[{"code":"Sx00-5962-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"170364","type":"LOCAL"},{"code":"418248","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 170364 = Hospital System Supply Identifier | 418248 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 10MM","code_information":[{"code":"Sx00-5962-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154591","type":"LOCAL"},{"code":"298163","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154591 = Hospital System Supply Identifier | 298163 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 12MM","code_information":[{"code":"Sx00-5962-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154592","type":"LOCAL"},{"code":"298164","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154592 = Hospital System Supply Identifier | 298164 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 17MM","code_information":[{"code":"Sx00-5962-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154593","type":"LOCAL"},{"code":"298166","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154593 = Hospital System Supply Identifier | 298166 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 20MM","code_information":[{"code":"Sx00-5962-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154594","type":"LOCAL"},{"code":"298167","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154594 = Hospital System Supply Identifier | 298167 = Lawson ID"}]},{"description":"IMP SURF PROLNG FLX 14 E F 5-6","code_information":[{"code":"Sx00-5962-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"166087","type":"LOCAL"},{"code":"390516","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 166087 = Hospital System Supply Identifier | 390516 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 5-6 23MM","code_information":[{"code":"Sx00-5962-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196567","type":"LOCAL"},{"code":"412547","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 196567 = Hospital System Supply Identifier | 412547 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 10MM","code_information":[{"code":"Sx00-5962-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193382","type":"LOCAL"},{"code":"298168","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193382 = Hospital System Supply Identifier | 298168 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 12MM","code_information":[{"code":"Sx00-5962-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193383","type":"LOCAL"},{"code":"298169","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193383 = Hospital System Supply Identifier | 298169 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 14MM","code_information":[{"code":"Sx00-5962-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193384","type":"LOCAL"},{"code":"298170","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193384 = Hospital System Supply Identifier | 298170 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 17MM","code_information":[{"code":"Sx00-5962-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193385","type":"LOCAL"},{"code":"298171","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193385 = Hospital System Supply Identifier | 298171 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 20MM","code_information":[{"code":"Sx00-5962-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193386","type":"LOCAL"},{"code":"298172","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193386 = Hospital System Supply Identifier | 298172 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 5-6 23MM","code_information":[{"code":"Sx00-5962-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196568","type":"LOCAL"},{"code":"412548","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 196568 = Hospital System Supply Identifier | 412548 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 5-6 23MM","code_information":[{"code":"Sx00-5962-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196569","type":"LOCAL"},{"code":"412549","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 196569 = Hospital System Supply Identifier | 412549 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 17MM","code_information":[{"code":"Sx00-5962-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193387","type":"LOCAL"},{"code":"298176","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193387 = Hospital System Supply Identifier | 298176 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 20MM","code_information":[{"code":"Sx00-5962-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193388","type":"LOCAL"},{"code":"298177","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193388 = Hospital System Supply Identifier | 298177 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 12MM","code_information":[{"code":"Sx00-5962-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154596","type":"LOCAL"},{"code":"298174","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154596 = Hospital System Supply Identifier | 298174 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 10MM","code_information":[{"code":"Sx00-5962-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154595","type":"LOCAL"},{"code":"298173","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154595 = Hospital System Supply Identifier | 298173 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 14MM","code_information":[{"code":"Sx00-5962-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154597","type":"LOCAL"},{"code":"298175","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154597 = Hospital System Supply Identifier | 298175 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 7-10 10MM","code_information":[{"code":"Sx00-5962-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178298","type":"LOCAL"},{"code":"298178","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178298 = Hospital System Supply Identifier | 298178 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 7-10 12MM","code_information":[{"code":"Sx00-5962-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193389","type":"LOCAL"},{"code":"298179","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193389 = Hospital System Supply Identifier | 298179 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 7-10 14MM","code_information":[{"code":"Sx00-5962-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193390","type":"LOCAL"},{"code":"298180","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193390 = Hospital System Supply Identifier | 298180 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 7-10 17MM","code_information":[{"code":"Sx00-5962-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193391","type":"LOCAL"},{"code":"298181","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193391 = Hospital System Supply Identifier | 298181 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 7-10 20MM","code_information":[{"code":"Sx00-5962-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193392","type":"LOCAL"},{"code":"298182","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193392 = Hospital System Supply Identifier | 298182 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 7-10 23","code_information":[{"code":"Sx00-5962-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196570","type":"LOCAL"},{"code":"412550","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 196570 = Hospital System Supply Identifier | 412550 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 7-10 23","code_information":[{"code":"Sx00-5962-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196571","type":"LOCAL"},{"code":"412551","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 196571 = Hospital System Supply Identifier | 412551 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 7-10 20MM","code_information":[{"code":"Sx00-5962-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193395","type":"LOCAL"},{"code":"298187","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193395 = Hospital System Supply Identifier | 298187 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 7-10 17MM","code_information":[{"code":"Sx00-5962-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154599","type":"LOCAL"},{"code":"298186","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154599 = Hospital System Supply Identifier | 298186 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 7-10 10MM","code_information":[{"code":"Sx00-5962-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154598","type":"LOCAL"},{"code":"298183","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154598 = Hospital System Supply Identifier | 298183 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 7-10 12MM","code_information":[{"code":"Sx00-5962-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193393","type":"LOCAL"},{"code":"298184","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193393 = Hospital System Supply Identifier | 298184 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 7-10 14MM","code_information":[{"code":"Sx00-5962-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193394","type":"LOCAL"},{"code":"298185","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193394 = Hospital System Supply Identifier | 298185 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZC","code_information":[{"code":"Sx00-5964-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193396","type":"LOCAL"},{"code":"298190","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193396 = Hospital System Supply Identifier | 298190 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZC","code_information":[{"code":"Sx00-5964-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193397","type":"LOCAL"},{"code":"298191","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193397 = Hospital System Supply Identifier | 298191 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZD","code_information":[{"code":"Sx00-5964-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178299","type":"LOCAL"},{"code":"298193","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178299 = Hospital System Supply Identifier | 298193 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZD","code_information":[{"code":"Sx00-5964-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193398","type":"LOCAL"},{"code":"298192","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193398 = Hospital System Supply Identifier | 298192 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZE","code_information":[{"code":"Sx00-5964-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154600","type":"LOCAL"},{"code":"298195","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154600 = Hospital System Supply Identifier | 298195 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZE","code_information":[{"code":"Sx00-5964-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169650","type":"LOCAL"},{"code":"298194","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 169650 = Hospital System Supply Identifier | 298194 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZF","code_information":[{"code":"Sx00-5964-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154601","type":"LOCAL"},{"code":"298197","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154601 = Hospital System Supply Identifier | 298197 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZF","code_information":[{"code":"Sx00-5964-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"159832","type":"LOCAL"},{"code":"343847","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 159832 = Hospital System Supply Identifier | 343847 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZG","code_information":[{"code":"Sx00-5964-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154603","type":"LOCAL"},{"code":"298199","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154603 = Hospital System Supply Identifier | 298199 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZG","code_information":[{"code":"Sx00-5964-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154602","type":"LOCAL"},{"code":"298198","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 154602 = Hospital System Supply Identifier | 298198 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 10 AB/1-2","code_information":[{"code":"Sx00-5964-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202274","type":"LOCAL"},{"code":"452372","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202274 = Hospital System Supply Identifier | 452372 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 12 AB/1-2","code_information":[{"code":"Sx00-5964-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202277","type":"LOCAL"},{"code":"452375","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202277 = Hospital System Supply Identifier | 452375 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 14 AB/1-2","code_information":[{"code":"Sx00-5964-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202281","type":"LOCAL"},{"code":"452379","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202281 = Hospital System Supply Identifier | 452379 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 17 AB/1-2","code_information":[{"code":"Sx00-5964-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202288","type":"LOCAL"},{"code":"452386","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202288 = Hospital System Supply Identifier | 452386 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 20 AB/1-2","code_information":[{"code":"Sx00-5964-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202294","type":"LOCAL"},{"code":"452392","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202294 = Hospital System Supply Identifier | 452392 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 23 AB/1-2","code_information":[{"code":"Sx00-5964-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202303","type":"LOCAL"},{"code":"452401","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202303 = Hospital System Supply Identifier | 452401 = Lawson ID"}]},{"description":"IMP TIB INS NXGN CD 1-2 10MM","code_information":[{"code":"Sx00-5964-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194952","type":"LOCAL"},{"code":"360610","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194952 = Hospital System Supply Identifier | 360610 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 12 CD/1-2","code_information":[{"code":"Sx00-5964-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202279","type":"LOCAL"},{"code":"452377","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202279 = Hospital System Supply Identifier | 452377 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 14 CD/1-2","code_information":[{"code":"Sx00-5964-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202283","type":"LOCAL"},{"code":"452381","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202283 = Hospital System Supply Identifier | 452381 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 17 CD/1-2","code_information":[{"code":"Sx00-5964-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202290","type":"LOCAL"},{"code":"452388","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202290 = Hospital System Supply Identifier | 452388 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 20 CD/1-2","code_information":[{"code":"Sx00-5964-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202296","type":"LOCAL"},{"code":"452394","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202296 = Hospital System Supply Identifier | 452394 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 23 CD/1-2","code_information":[{"code":"Sx00-5964-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202305","type":"LOCAL"},{"code":"452403","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202305 = Hospital System Supply Identifier | 452403 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 23 CD/3-4","code_information":[{"code":"Sx00-5964-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202306","type":"LOCAL"},{"code":"452404","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202306 = Hospital System Supply Identifier | 452404 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 20 CD/3-4","code_information":[{"code":"Sx00-5964-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202297","type":"LOCAL"},{"code":"452395","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202297 = Hospital System Supply Identifier | 452395 = Lawson ID"}]},{"description":"IMP TIB INS NXGN CD 3-4 17MM","code_information":[{"code":"Sx00-5964-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194956","type":"LOCAL"},{"code":"360614","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194956 = Hospital System Supply Identifier | 360614 = Lawson ID"}]},{"description":"IMP TIB INS NXGN CD 3-4 10MM","code_information":[{"code":"Sx00-5964-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194953","type":"LOCAL"},{"code":"360611","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194953 = Hospital System Supply Identifier | 360611 = Lawson ID"}]},{"description":"IMP TIB INS NXGN CD 3-4 12MM","code_information":[{"code":"Sx00-5964-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194954","type":"LOCAL"},{"code":"360612","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194954 = Hospital System Supply Identifier | 360612 = Lawson ID"}]},{"description":"IMP TIB INS NXGN CD 3-4 14MM","code_information":[{"code":"Sx00-5964-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194955","type":"LOCAL"},{"code":"360613","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194955 = Hospital System Supply Identifier | 360613 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 10 AB/3-4","code_information":[{"code":"Sx00-5964-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202275","type":"LOCAL"},{"code":"452373","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202275 = Hospital System Supply Identifier | 452373 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 12 AB/3-4","code_information":[{"code":"Sx00-5964-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202278","type":"LOCAL"},{"code":"452376","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202278 = Hospital System Supply Identifier | 452376 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 14 AB/3-4","code_information":[{"code":"Sx00-5964-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202282","type":"LOCAL"},{"code":"452380","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202282 = Hospital System Supply Identifier | 452380 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 17 AB/3-4","code_information":[{"code":"Sx00-5964-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202289","type":"LOCAL"},{"code":"452387","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202289 = Hospital System Supply Identifier | 452387 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 20 AB/3-4","code_information":[{"code":"Sx00-5964-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202295","type":"LOCAL"},{"code":"452393","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202295 = Hospital System Supply Identifier | 452393 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 23 AB/3-4","code_information":[{"code":"Sx00-5964-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202304","type":"LOCAL"},{"code":"452402","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202304 = Hospital System Supply Identifier | 452402 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 23 EF/3-4","code_information":[{"code":"Sx00-5964-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202308","type":"LOCAL"},{"code":"452406","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202308 = Hospital System Supply Identifier | 452406 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 3-4 20MM","code_information":[{"code":"Sx00-5964-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194961","type":"LOCAL"},{"code":"360619","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194961 = Hospital System Supply Identifier | 360619 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 3-4 17MM","code_information":[{"code":"Sx00-5964-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194960","type":"LOCAL"},{"code":"360618","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194960 = Hospital System Supply Identifier | 360618 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 3-4 12MM","code_information":[{"code":"Sx00-5964-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194958","type":"LOCAL"},{"code":"360616","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194958 = Hospital System Supply Identifier | 360616 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 3-4 10MM","code_information":[{"code":"Sx00-5964-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194957","type":"LOCAL"},{"code":"360615","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194957 = Hospital System Supply Identifier | 360615 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 3-4 14MM","code_information":[{"code":"Sx00-5964-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194959","type":"LOCAL"},{"code":"360617","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194959 = Hospital System Supply Identifier | 360617 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 5-6 17MM","code_information":[{"code":"Sx00-5964-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194964","type":"LOCAL"},{"code":"360622","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194964 = Hospital System Supply Identifier | 360622 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 5-6 12MM","code_information":[{"code":"Sx00-5964-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194962","type":"LOCAL"},{"code":"360620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194962 = Hospital System Supply Identifier | 360620 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 5-6 14MM","code_information":[{"code":"Sx00-5964-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194963","type":"LOCAL"},{"code":"360621","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194963 = Hospital System Supply Identifier | 360621 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 20 EF/5-6","code_information":[{"code":"Sx00-5964-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202299","type":"LOCAL"},{"code":"452397","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202299 = Hospital System Supply Identifier | 452397 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 23 EF/5-6","code_information":[{"code":"Sx00-5964-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202309","type":"LOCAL"},{"code":"452407","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202309 = Hospital System Supply Identifier | 452407 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 5-6 10MM","code_information":[{"code":"Sx00-5964-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303556","type":"LOCAL"},{"code":"522513","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303556 = Hospital System Supply Identifier | 522513 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 20 CD/5-6","code_information":[{"code":"Sx00-5964-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202298","type":"LOCAL"},{"code":"452396","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202298 = Hospital System Supply Identifier | 452396 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 14 CD/5-6","code_information":[{"code":"Sx00-5964-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202284","type":"LOCAL"},{"code":"452382","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202284 = Hospital System Supply Identifier | 452382 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 23 CD/5-6","code_information":[{"code":"Sx00-5964-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202307","type":"LOCAL"},{"code":"452405","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202307 = Hospital System Supply Identifier | 452405 = Lawson ID"}]},{"description":"IMP TIB INS NXGN CD 5-6 17MM","code_information":[{"code":"Sx00-5964-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194966","type":"LOCAL"},{"code":"360624","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194966 = Hospital System Supply Identifier | 360624 = Lawson ID"}]},{"description":"IMP TIB INS NXGN CD 5-6 10MM","code_information":[{"code":"Sx00-5964-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194965","type":"LOCAL"},{"code":"360623","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194965 = Hospital System Supply Identifier | 360623 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 12 CD/5-6","code_information":[{"code":"Sx00-5964-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202280","type":"LOCAL"},{"code":"452378","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202280 = Hospital System Supply Identifier | 452378 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 20 GH/5-6","code_information":[{"code":"Sx00-5964-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202301","type":"LOCAL"},{"code":"452399","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202301 = Hospital System Supply Identifier | 452399 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 17 GH/5-6","code_information":[{"code":"Sx00-5964-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202292","type":"LOCAL"},{"code":"452390","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202292 = Hospital System Supply Identifier | 452390 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 23 GH/5-6","code_information":[{"code":"Sx00-5964-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202311","type":"LOCAL"},{"code":"452409","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202311 = Hospital System Supply Identifier | 452409 = Lawson ID"}]},{"description":"IMP TIB INS NXGN GH 5-6 12MM","code_information":[{"code":"Sx00-5964-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194968","type":"LOCAL"},{"code":"360626","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194968 = Hospital System Supply Identifier | 360626 = Lawson ID"}]},{"description":"IMP TIB INS NXGN GH 5-6 10MM","code_information":[{"code":"Sx00-5964-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194967","type":"LOCAL"},{"code":"360625","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194967 = Hospital System Supply Identifier | 360625 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 14 GH/5-6","code_information":[{"code":"Sx00-5964-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202286","type":"LOCAL"},{"code":"452384","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202286 = Hospital System Supply Identifier | 452384 = Lawson ID"}]},{"description":"IMP TIB INS NXGN GH 7-10 12MM","code_information":[{"code":"Sx00-5964-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194969","type":"LOCAL"},{"code":"360627","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194969 = Hospital System Supply Identifier | 360627 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 10 GH/7-10","code_information":[{"code":"Sx00-5964-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202276","type":"LOCAL"},{"code":"452374","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202276 = Hospital System Supply Identifier | 452374 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 14 GH/7-10","code_information":[{"code":"Sx00-5964-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202287","type":"LOCAL"},{"code":"452385","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202287 = Hospital System Supply Identifier | 452385 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 17 GH/7-10","code_information":[{"code":"Sx00-5964-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202293","type":"LOCAL"},{"code":"452391","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202293 = Hospital System Supply Identifier | 452391 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 20 GH/7-10","code_information":[{"code":"Sx00-5964-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202302","type":"LOCAL"},{"code":"452400","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202302 = Hospital System Supply Identifier | 452400 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 23 GH/7-10","code_information":[{"code":"Sx00-5964-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202312","type":"LOCAL"},{"code":"452410","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202312 = Hospital System Supply Identifier | 452410 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 23 EF/7-10","code_information":[{"code":"Sx00-5964-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202310","type":"LOCAL"},{"code":"452408","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202310 = Hospital System Supply Identifier | 452408 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 20 EF/7-10","code_information":[{"code":"Sx00-5964-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202300","type":"LOCAL"},{"code":"452398","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202300 = Hospital System Supply Identifier | 452398 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 17 EF/7-10","code_information":[{"code":"Sx00-5964-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202291","type":"LOCAL"},{"code":"452389","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202291 = Hospital System Supply Identifier | 452389 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 7-10 12MM","code_information":[{"code":"Sx00-5964-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194971","type":"LOCAL"},{"code":"360629","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194971 = Hospital System Supply Identifier | 360629 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 7-10 10MM","code_information":[{"code":"Sx00-5964-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194970","type":"LOCAL"},{"code":"360628","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194970 = Hospital System Supply Identifier | 360628 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 14 EF/7-10","code_information":[{"code":"Sx00-5964-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202285","type":"LOCAL"},{"code":"452383","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202285 = Hospital System Supply Identifier | 452383 = Lawson ID"}]},{"description":"IMP CR POLY TIB SIZE 3 YEL","code_information":[{"code":"Sx00-5966-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662247","type":"LOCAL"},{"code":"446532","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662247 = Hospital System Supply Identifier | 446532 = Lawson ID"}]},{"description":"IMP CR POLY TIB SZ 3 YEL 10MM","code_information":[{"code":"Sx00-5966-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328543","type":"LOCAL"},{"code":"458221","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 328543 = Hospital System Supply Identifier | 458221 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT CR SZ3 14","code_information":[{"code":"Sx00-5966-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303557","type":"LOCAL"},{"code":"522514","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303557 = Hospital System Supply Identifier | 522514 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT CR SZ3 17","code_information":[{"code":"Sx00-5966-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303558","type":"LOCAL"},{"code":"522515","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303558 = Hospital System Supply Identifier | 522515 = Lawson ID"}]},{"description":"IMP KNEE-C TIB NXGN YEL SZ4 14","code_information":[{"code":"Sx00-5966-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"330547","type":"LOCAL"},{"code":"459446","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 330547 = Hospital System Supply Identifier | 459446 = Lawson ID"}]},{"description":"IMP KNEE-C TIB BSPLT NX SZ4 12","code_information":[{"code":"Sx00-5966-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"330223","type":"LOCAL"},{"code":"427287","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 330223 = Hospital System Supply Identifier | 427287 = Lawson ID"}]},{"description":"IMP KNEE-C TIB BSPLT NX SZ4 17","code_information":[{"code":"Sx00-5966-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329892","type":"LOCAL"},{"code":"395491","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329892 = Hospital System Supply Identifier | 395491 = Lawson ID"}]},{"description":"IMP KNEE-C TIB BSPLT NX SZ4 10","code_information":[{"code":"Sx00-5966-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329891","type":"LOCAL"},{"code":"395490","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329891 = Hospital System Supply Identifier | 395490 = Lawson ID"}]},{"description":"IMP KNEE-C TIB BSPLT NXGN","code_information":[{"code":"Sx00-5966-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329893","type":"LOCAL"},{"code":"395492","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329893 = Hospital System Supply Identifier | 395492 = Lawson ID"}]},{"description":"IMP KNEE-C TIB BSPLT NX 10X74","code_information":[{"code":"Sx00-5966-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329894","type":"LOCAL"},{"code":"395493","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329894 = Hospital System Supply Identifier | 395493 = Lawson ID"}]},{"description":"IMP KNEE TIB NXGN SZ5 GRN 10MM","code_information":[{"code":"Sx00-5966-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"330295","type":"LOCAL"},{"code":"447379","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 330295 = Hospital System Supply Identifier | 447379 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT CR SZ5 17","code_information":[{"code":"Sx00-5966-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303559","type":"LOCAL"},{"code":"522516","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303559 = Hospital System Supply Identifier | 522516 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN 10X74","code_information":[{"code":"Sx00-5966-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324823","type":"LOCAL"},{"code":"324151","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 324823 = Hospital System Supply Identifier | 324151 = Lawson ID"}]},{"description":"IMP KNEE-C TIB NXGN SZ6 14MM","code_information":[{"code":"Sx00-5966-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329895","type":"LOCAL"},{"code":"395494","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329895 = Hospital System Supply Identifier | 395494 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT CR SZ6 12","code_information":[{"code":"Sx00-5966-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303560","type":"LOCAL"},{"code":"522517","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303560 = Hospital System Supply Identifier | 522517 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT CR SZ6 17","code_information":[{"code":"Sx00-5966-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303561","type":"LOCAL"},{"code":"522518","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303561 = Hospital System Supply Identifier | 522518 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT CR SZ7 17","code_information":[{"code":"Sx00-5966-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303563","type":"LOCAL"},{"code":"522520","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303563 = Hospital System Supply Identifier | 522520 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT CR SZ7 12","code_information":[{"code":"Sx00-5966-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303562","type":"LOCAL"},{"code":"522519","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303562 = Hospital System Supply Identifier | 522519 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN 10X82","code_information":[{"code":"Sx00-5966-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324824","type":"LOCAL"},{"code":"324152","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 324824 = Hospital System Supply Identifier | 324152 = Lawson ID"}]},{"description":"IMP CR POLY TIB SZ 7 BL 14MM","code_information":[{"code":"Sx00-5966-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328544","type":"LOCAL"},{"code":"458222","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 328544 = Hospital System Supply Identifier | 458222 = Lawson ID"}]},{"description":"IMP CR POLY TIB SZ 8 BL 10MM","code_information":[{"code":"Sx00-5966-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328545","type":"LOCAL"},{"code":"458223","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 328545 = Hospital System Supply Identifier | 458223 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT CR SZ8 12","code_information":[{"code":"Sx00-5966-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303564","type":"LOCAL"},{"code":"522521","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303564 = Hospital System Supply Identifier | 522521 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT CR SZ8 14","code_information":[{"code":"Sx00-5966-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303565","type":"LOCAL"},{"code":"522522","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303565 = Hospital System Supply Identifier | 522522 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT CR SZ8 17","code_information":[{"code":"Sx00-5966-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303566","type":"LOCAL"},{"code":"522523","type":"LOCAL"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303566 = Hospital System Supply Identifier | 522523 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP STD SZ C LT","code_information":[{"code":"Sx00-5966-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193125","type":"LOCAL"},{"code":"247382","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193125 = Hospital System Supply Identifier | 247382 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN RT SZC","code_information":[{"code":"Sx00-5966-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196572","type":"LOCAL"},{"code":"412552","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 196572 = Hospital System Supply Identifier | 412552 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP STD SZ D RT","code_information":[{"code":"Sx00-5966-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193122","type":"LOCAL"},{"code":"247373","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193122 = Hospital System Supply Identifier | 247373 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP STD SZ D LT","code_information":[{"code":"Sx00-5966-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193124","type":"LOCAL"},{"code":"247381","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193124 = Hospital System Supply Identifier | 247381 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP STD SZ E RT","code_information":[{"code":"Sx00-5966-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193117","type":"LOCAL"},{"code":"247272","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193117 = Hospital System Supply Identifier | 247272 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP STD SZ E LT","code_information":[{"code":"Sx00-5966-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193120","type":"LOCAL"},{"code":"247277","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193120 = Hospital System Supply Identifier | 247277 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP STD SZ F LT","code_information":[{"code":"Sx00-5966-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193121","type":"LOCAL"},{"code":"247279","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193121 = Hospital System Supply Identifier | 247279 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP STD SZ F RT","code_information":[{"code":"Sx00-5966-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193119","type":"LOCAL"},{"code":"247274","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193119 = Hospital System Supply Identifier | 247274 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP STD SZ G LT","code_information":[{"code":"Sx00-5966-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193108","type":"LOCAL"},{"code":"246743","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193108 = Hospital System Supply Identifier | 246743 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NGEN RT SZG","code_information":[{"code":"Sx00-5966-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193123","type":"LOCAL"},{"code":"247380","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193123 = Hospital System Supply Identifier | 247380 = Lawson ID"}]},{"description":"SET TOTAL JOINT 0-3 MODULAR PLATE LEFT VARUS NEXGEN","code_information":[{"code":"Sx00-5967-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1104200","type":"LOCAL"},{"code":"S119277","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1104200 = Hospital System Supply Identifier | S119277 = Lawson ID"}]},{"description":"IMP KNEE FEM LPSFLX RT SZC","code_information":[{"code":"Sx00-5968-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303567","type":"LOCAL"},{"code":"522524","type":"LOCAL"}],"standard_charges":[{"gross_charge":6440.0,"discounted_cash":2254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303567 = Hospital System Supply Identifier | 522524 = Lawson ID"}]},{"description":"IMP KNEE FEM LPSFLX RT SZC","code_information":[{"code":"Sx00-5968-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303568","type":"LOCAL"},{"code":"522525","type":"LOCAL"}],"standard_charges":[{"gross_charge":6440.0,"discounted_cash":2254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303568 = Hospital System Supply Identifier | 522525 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN RT SZD","code_information":[{"code":"Sx00-5968-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326824","type":"LOCAL"},{"code":"401999","type":"LOCAL"}],"standard_charges":[{"gross_charge":6440.0,"discounted_cash":2254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326824 = Hospital System Supply Identifier | 401999 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LT SZ","code_information":[{"code":"Sx00-5968-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327595","type":"LOCAL"},{"code":"419993","type":"LOCAL"}],"standard_charges":[{"gross_charge":6440.0,"discounted_cash":2254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 327595 = Hospital System Supply Identifier | 419993 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN RT SZE","code_information":[{"code":"Sx00-5968-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326826","type":"LOCAL"},{"code":"402001","type":"LOCAL"}],"standard_charges":[{"gross_charge":6440.0,"discounted_cash":2254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326826 = Hospital System Supply Identifier | 402001 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN LT SZE","code_information":[{"code":"Sx00-5968-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326825","type":"LOCAL"},{"code":"402000","type":"LOCAL"}],"standard_charges":[{"gross_charge":6440.0,"discounted_cash":2254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326825 = Hospital System Supply Identifier | 402000 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN LT SZF","code_information":[{"code":"Sx00-5968-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326827","type":"LOCAL"},{"code":"402002","type":"LOCAL"}],"standard_charges":[{"gross_charge":6440.0,"discounted_cash":2254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326827 = Hospital System Supply Identifier | 402002 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN RT SZF","code_information":[{"code":"Sx00-5968-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326828","type":"LOCAL"},{"code":"402003","type":"LOCAL"}],"standard_charges":[{"gross_charge":6440.0,"discounted_cash":2254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326828 = Hospital System Supply Identifier | 402003 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN RT SZG","code_information":[{"code":"Sx00-5968-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328508","type":"LOCAL"},{"code":"457513","type":"LOCAL"}],"standard_charges":[{"gross_charge":6440.0,"discounted_cash":2254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 328508 = Hospital System Supply Identifier | 457513 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN LT SZG","code_information":[{"code":"Sx00-5968-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328339","type":"LOCAL"},{"code":"448628","type":"LOCAL"}],"standard_charges":[{"gross_charge":6440.0,"discounted_cash":2254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 328339 = Hospital System Supply Identifier | 448628 = Lawson ID"}]},{"description":"SPACER FEMORAL +3MM NSTRL REVISION TENSOR SS KNEE NEXGEN V-STAT","code_information":[{"code":"Sx00-5969-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1104790","type":"LOCAL"},{"code":"S652539","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1104790 = Hospital System Supply Identifier | S652539 = Lawson ID"}]},{"description":"GUIDE PIN NEXGEN LPS-FX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019430","type":"LOCAL"},{"code":"869378","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1019430 = Hospital System Supply Identifier | 869378 = Lawson ID"}]},{"description":"GUIDE PIN NEXGEN CR-FX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019429","type":"LOCAL"},{"code":"869377","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1019429 = Hospital System Supply Identifier | 869377 = Lawson ID"}]},{"description":"SET PIN GDE CT PRSNA PREF PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848395","type":"LOCAL"},{"code":"780148","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 848395 = Hospital System Supply Identifier | 780148 = Lawson ID"}]},{"description":"SET PIN GDE CT PRSNA PREF CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848394","type":"LOCAL"},{"code":"780147","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 848394 = Hospital System Supply Identifier | 780147 = Lawson ID"}]},{"description":"SET PIN GDE CT PSI NXGN CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848387","type":"LOCAL"},{"code":"780140","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 848387 = Hospital System Supply Identifier | 780140 = Lawson ID"}]},{"description":"SET PIN GDE CT PRSNA CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848392","type":"LOCAL"},{"code":"780145","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 848392 = Hospital System Supply Identifier | 780145 = Lawson ID"}]},{"description":"SET PIN GDE CT N-K FLEX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848391","type":"LOCAL"},{"code":"780144","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 848391 = Hospital System Supply Identifier | 780144 = Lawson ID"}]},{"description":"GUIDE PIN NEXGEN PSN CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019431","type":"LOCAL"},{"code":"869379","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1019431 = Hospital System Supply Identifier | 869379 = Lawson ID"}]},{"description":"SET PIN GDE CT PSI NXGN CR-FX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848388","type":"LOCAL"},{"code":"780141","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 848388 = Hospital System Supply Identifier | 780141 = Lawson ID"}]},{"description":"SET PIN GDE CT PRSNA PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848393","type":"LOCAL"},{"code":"780146","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 848393 = Hospital System Supply Identifier | 780146 = Lawson ID"}]},{"description":"GUIDE PIN NEXGEN PSN PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019432","type":"LOCAL"},{"code":"869380","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1019432 = Hospital System Supply Identifier | 869380 = Lawson ID"}]},{"description":"SET PIN GDE CT PSI NXGN LPS-FX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848390","type":"LOCAL"},{"code":"780143","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 848390 = Hospital System Supply Identifier | 780143 = Lawson ID"}]},{"description":"GUIDE PIN NEXGEN PREF PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019434","type":"LOCAL"},{"code":"869382","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1019434 = Hospital System Supply Identifier | 869382 = Lawson ID"}]},{"description":"GUIDE PIN NEXGEN CR-FX CT","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019435","type":"LOCAL"},{"code":"869383","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1019435 = Hospital System Supply Identifier | 869383 = Lawson ID"}]},{"description":"GUIDE PIN NEXGEN LPS-FX CT","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019436","type":"LOCAL"},{"code":"869384","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1019436 = Hospital System Supply Identifier | 869384 = Lawson ID"}]},{"description":"SET GUIDE PIN NEXGEN CR-FX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019437","type":"LOCAL"},{"code":"869385","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1019437 = Hospital System Supply Identifier | 869385 = Lawson ID"}]},{"description":"SET GUIDE PIN NEXGEN LPS-FX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019438","type":"LOCAL"},{"code":"869386","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1019438 = Hospital System Supply Identifier | 869386 = Lawson ID"}]},{"description":"SET GUIDE PIN NEXGEN PSN CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019439","type":"LOCAL"},{"code":"869387","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1019439 = Hospital System Supply Identifier | 869387 = Lawson ID"}]},{"description":"SET GUIDE PIN NEXGEN PSN PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019440","type":"LOCAL"},{"code":"869388","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1019440 = Hospital System Supply Identifier | 869388 = Lawson ID"}]},{"description":"SET GUIDE PIN NEXGEN PREF CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019441","type":"LOCAL"},{"code":"869389","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1019441 = Hospital System Supply Identifier | 869389 = Lawson ID"}]},{"description":"SET GUIDE PIN NEXGEN PREF PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019442","type":"LOCAL"},{"code":"869390","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1019442 = Hospital System Supply Identifier | 869390 = Lawson ID"}]},{"description":"GUIDE PIN NEXGEN CR-FX CT S","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019443","type":"LOCAL"},{"code":"869391","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1019443 = Hospital System Supply Identifier | 869391 = Lawson ID"}]},{"description":"GUIDE PIN NEXGEN LPS-FX CT S","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019444","type":"LOCAL"},{"code":"869392","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1019444 = Hospital System Supply Identifier | 869392 = Lawson ID"}]},{"description":"SET PIN GDE PSI PRSNA PREF PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848386","type":"LOCAL"},{"code":"780139","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 848386 = Hospital System Supply Identifier | 780139 = Lawson ID"}]},{"description":"GUIDE PIN NEXGEN PREF CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019433","type":"LOCAL"},{"code":"869381","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1019433 = Hospital System Supply Identifier | 869381 = Lawson ID"}]},{"description":"SET PIN GDE PSI PRSNA PREF CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848385","type":"LOCAL"},{"code":"780138","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 848385 = Hospital System Supply Identifier | 780138 = Lawson ID"}]},{"description":"SET PIN GDE CT PSI NXGN LPS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848389","type":"LOCAL"},{"code":"780142","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 848389 = Hospital System Supply Identifier | 780142 = Lawson ID"}]},{"description":"SET PIN GDE PSI PRSNA CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848383","type":"LOCAL"},{"code":"780136","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 848383 = Hospital System Supply Identifier | 780136 = Lawson ID"}]},{"description":"PIN GDE PAT SPEC CR FLX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"329878","type":"LOCAL"},{"code":"394975","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329878 = Hospital System Supply Identifier | 394975 = Lawson ID"}]},{"description":"PIN GDE PAT SPEC LPS FLX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"178720","type":"LOCAL"},{"code":"394976","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178720 = Hospital System Supply Identifier | 394976 = Lawson ID"}]},{"description":"PIN GDE FEM PSI PRSNA CR TIB","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"473211","type":"LOCAL"},{"code":"437792","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 473211 = Hospital System Supply Identifier | 437792 = Lawson ID"}]},{"description":"BONE MODEL KNEE","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"179017","type":"LOCAL"},{"code":"441627","type":"LOCAL"}],"standard_charges":[{"gross_charge":1800.75,"discounted_cash":630.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 179017 = Hospital System Supply Identifier | 441627 = Lawson ID"}]},{"description":"PIN GUIDE","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"662248","type":"LOCAL"},{"code":"446534","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662248 = Hospital System Supply Identifier | 446534 = Lawson ID"}]},{"description":"CPI PIN GUIDE","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"662249","type":"LOCAL"},{"code":"446536","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662249 = Hospital System Supply Identifier | 446536 = Lawson ID"}]},{"description":"PIN MODEL","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"662250","type":"LOCAL"},{"code":"446538","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662250 = Hospital System Supply Identifier | 446538 = Lawson ID"}]},{"description":"PIN GUIDE","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"662251","type":"LOCAL"},{"code":"446539","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662251 = Hospital System Supply Identifier | 446539 = Lawson ID"}]},{"description":"GUIDE PT SPECIFIC LPS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"303570","type":"LOCAL"},{"code":"522527","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303570 = Hospital System Supply Identifier | 522527 = Lawson ID"}]},{"description":"GUIDE SURG KT LPS CT PSI","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"303572","type":"LOCAL"},{"code":"522529","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303572 = Hospital System Supply Identifier | 522529 = Lawson ID"}]},{"description":"GUIDE LPS FLEX CT PSI","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"303573","type":"LOCAL"},{"code":"522530","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303573 = Hospital System Supply Identifier | 522530 = Lawson ID"}]},{"description":"GUIDE NK FLEX CT PSI","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"303574","type":"LOCAL"},{"code":"522531","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303574 = Hospital System Supply Identifier | 522531 = Lawson ID"}]},{"description":"GUIDE PT SPECIFIC CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"303569","type":"LOCAL"},{"code":"522526","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303569 = Hospital System Supply Identifier | 522526 = Lawson ID"}]},{"description":"GUIDE PIN FEM TIB PRSNA PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"303576","type":"LOCAL"},{"code":"522533","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303576 = Hospital System Supply Identifier | 522533 = Lawson ID"}]},{"description":"SET PIN GDE N-K FLEX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848382","type":"LOCAL"},{"code":"780135","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 848382 = Hospital System Supply Identifier | 780135 = Lawson ID"}]},{"description":"GUIDE PIN PSI PRSNA NGK CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"303575","type":"LOCAL"},{"code":"522532","type":"LOCAL"}],"standard_charges":[{"gross_charge":3890.25,"discounted_cash":1361.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303575 = Hospital System Supply Identifier | 522532 = Lawson ID"}]},{"description":"SET PIN GDE NXGN LPS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848380","type":"LOCAL"},{"code":"780133","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 848380 = Hospital System Supply Identifier | 780133 = Lawson ID"}]},{"description":"SET PIN GDE NXGN CR-FX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848379","type":"LOCAL"},{"code":"780132","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 848379 = Hospital System Supply Identifier | 780132 = Lawson ID"}]},{"description":"SET PIN GDE NXGN CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848378","type":"LOCAL"},{"code":"780131","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 848378 = Hospital System Supply Identifier | 780131 = Lawson ID"}]},{"description":"SET PIN GDE NXGN LPS-FX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848381","type":"LOCAL"},{"code":"780134","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 848381 = Hospital System Supply Identifier | 780134 = Lawson ID"}]},{"description":"PIN GUIDE PSI PSN PREF PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"449687","type":"LOCAL"},{"code":"659253","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 449687 = Hospital System Supply Identifier | 659253 = Lawson ID"}]},{"description":"PIN GUIDE PSI PSN PREF CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"449686","type":"LOCAL"},{"code":"659252","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 449686 = Hospital System Supply Identifier | 659252 = Lawson ID"}]},{"description":"PIN GUIDE PSI PSN CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"449685","type":"LOCAL"},{"code":"659251","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 449685 = Hospital System Supply Identifier | 659251 = Lawson ID"}]},{"description":"GUIDE PIN PSI PRSNA NGK PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"303577","type":"LOCAL"},{"code":"522534","type":"LOCAL"}],"standard_charges":[{"gross_charge":3890.25,"discounted_cash":1361.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303577 = Hospital System Supply Identifier | 522534 = Lawson ID"}]},{"description":"PIN GUIDE PSI PSN PREF PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"581896","type":"LOCAL"},{"code":"676008","type":"LOCAL"}],"standard_charges":[{"gross_charge":4139.62,"discounted_cash":1448.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 581896 = Hospital System Supply Identifier | 676008 = Lawson ID"}]},{"description":"SET PIN GDE PSI PRSNA PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848384","type":"LOCAL"},{"code":"780137","type":"LOCAL"}],"standard_charges":[{"gross_charge":5712.52,"discounted_cash":1999.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 848384 = Hospital System Supply Identifier | 780137 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN SZC","code_information":[{"code":"Sx00-5970-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"148553","type":"LOCAL"},{"code":"235625","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 148553 = Hospital System Supply Identifier | 235625 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZC","code_information":[{"code":"Sx00-5970-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"160172","type":"LOCAL"},{"code":"347356","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 160172 = Hospital System Supply Identifier | 347356 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZD","code_information":[{"code":"Sx00-5970-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"148450","type":"LOCAL"},{"code":"235463","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 148450 = Hospital System Supply Identifier | 235463 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZD","code_information":[{"code":"Sx00-5970-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"148532","type":"LOCAL"},{"code":"235573","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 148532 = Hospital System Supply Identifier | 235573 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZE","code_information":[{"code":"Sx00-5970-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"148462","type":"LOCAL"},{"code":"235488","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 148462 = Hospital System Supply Identifier | 235488 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZE","code_information":[{"code":"Sx00-5970-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"148500","type":"LOCAL"},{"code":"235532","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 148500 = Hospital System Supply Identifier | 235532 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZF","code_information":[{"code":"Sx00-5970-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"160713","type":"LOCAL"},{"code":"353627","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 160713 = Hospital System Supply Identifier | 353627 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZF","code_information":[{"code":"Sx00-5970-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303578","type":"LOCAL"},{"code":"522535","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303578 = Hospital System Supply Identifier | 522535 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZG","code_information":[{"code":"Sx00-5970-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303580","type":"LOCAL"},{"code":"522537","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303580 = Hospital System Supply Identifier | 522537 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZH","code_information":[{"code":"Sx00-5970-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192138","type":"LOCAL"},{"code":"223561","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 192138 = Hospital System Supply Identifier | 223561 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZH","code_information":[{"code":"Sx00-5970-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192137","type":"LOCAL"},{"code":"223560","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 192137 = Hospital System Supply Identifier | 223560 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ1","code_information":[{"code":"Sx00-5970-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303587","type":"LOCAL"},{"code":"522544","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303587 = Hospital System Supply Identifier | 522544 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ2","code_information":[{"code":"Sx00-5970-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303588","type":"LOCAL"},{"code":"522545","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303588 = Hospital System Supply Identifier | 522545 = Lawson ID"}]},{"description":"PLATE TIB NEXGEN PGD YEL SZ3","code_information":[{"code":"Sx00-5970-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"330045","type":"LOCAL"},{"code":"410571","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 330045 = Hospital System Supply Identifier | 410571 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ4 LT","code_information":[{"code":"Sx00-5970-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178839","type":"LOCAL"},{"code":"418250","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178839 = Hospital System Supply Identifier | 418250 = Lawson ID"}]},{"description":"IMP KNEE PEG TIB PLT SZ5","code_information":[{"code":"Sx00-5970-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"181663","type":"LOCAL"},{"code":"453462","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 181663 = Hospital System Supply Identifier | 453462 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ6","code_information":[{"code":"Sx00-5970-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303599","type":"LOCAL"},{"code":"522556","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303599 = Hospital System Supply Identifier | 522556 = Lawson ID"}]},{"description":"IMP KNEE TIB PLT NXGN PGD SZ7","code_information":[{"code":"Sx00-5970-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329900","type":"LOCAL"},{"code":"395764","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329900 = Hospital System Supply Identifier | 395764 = Lawson ID"}]},{"description":"IMP KNEE TIB PLT NXGN PGD SZ8","code_information":[{"code":"Sx00-5970-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329901","type":"LOCAL"},{"code":"395765","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329901 = Hospital System Supply Identifier | 395765 = Lawson ID"}]},{"description":"IMP KNEE TIB PLT NXGN PGD SZ9","code_information":[{"code":"Sx00-5970-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303606","type":"LOCAL"},{"code":"522563","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303606 = Hospital System Supply Identifier | 522563 = Lawson ID"}]},{"description":"IMP KNEE TIB PLT NXGN PGD SZ10","code_information":[{"code":"Sx00-5970-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303607","type":"LOCAL"},{"code":"522564","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303607 = Hospital System Supply Identifier | 522564 = Lawson ID"}]},{"description":"COMPONENT PATELLAR 29 MM STANDARD 8 MM KNEE ULTEM PROVISIOINAL STRIPED PURPLE YELLOW GREEN BLUE NSTRL NEXGEN","code_information":[{"code":"Sx00-5971-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"171803","type":"LOCAL"},{"code":"439206","type":"LOCAL"}],"standard_charges":[{"gross_charge":229.77,"discounted_cash":80.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 171803 = Hospital System Supply Identifier | 439206 = Lawson ID"}]},{"description":"IMP KNEE PTELA THK SZ38 9.5MM","code_information":[{"code":"Sx00-5971-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303609","type":"LOCAL"},{"code":"522566","type":"LOCAL"}],"standard_charges":[{"gross_charge":229.77,"discounted_cash":80.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303609 = Hospital System Supply Identifier | 522566 = Lawson ID"}]},{"description":"PATELLA ALL POLY SZ 41MM","code_information":[{"code":"Sx00-5972-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167954","type":"LOCAL"},{"code":"204696","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 167954 = Hospital System Supply Identifier | 204696 = Lawson ID"}]},{"description":"PATELLA ALL POLY SZ 35MM","code_information":[{"code":"Sx00-5972-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167953","type":"LOCAL"},{"code":"204694","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 167953 = Hospital System Supply Identifier | 204694 = Lawson ID"}]},{"description":"IMP KNEE PTELA POLY NXGN 26MM","code_information":[{"code":"Sx00-5972-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303627","type":"LOCAL"},{"code":"522584","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303627 = Hospital System Supply Identifier | 522584 = Lawson ID"}]},{"description":"PATELLA ALL POLY 5972-65-29","code_information":[{"code":"Sx00-5972-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167630","type":"LOCAL"},{"code":"202394","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 167630 = Hospital System Supply Identifier | 202394 = Lawson ID"}]},{"description":"IMP KNEE PTELA 9.5MM SZ38","code_information":[{"code":"Sx00-5972-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"166598","type":"LOCAL"},{"code":"145755","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 166598 = Hospital System Supply Identifier | 145755 = Lawson ID"}]},{"description":"PATELLA ALL POLY SZ 32MM","code_information":[{"code":"Sx00-5972-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167934","type":"LOCAL"},{"code":"204413","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 167934 = Hospital System Supply Identifier | 204413 = Lawson ID"}]},{"description":"IMP KNEE ANT PURP SZ21 12MM","code_information":[{"code":"Sx00-5976-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328574","type":"LOCAL"},{"code":"458721","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 328574 = Hospital System Supply Identifier | 458721 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 1-2 10","code_information":[{"code":"Sx00-5976-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303639","type":"LOCAL"},{"code":"522596","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303639 = Hospital System Supply Identifier | 522596 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 1-2 14","code_information":[{"code":"Sx00-5976-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303640","type":"LOCAL"},{"code":"522597","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303640 = Hospital System Supply Identifier | 522597 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 1-2 17","code_information":[{"code":"Sx00-5976-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303641","type":"LOCAL"},{"code":"522598","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303641 = Hospital System Supply Identifier | 522598 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 1-2 20","code_information":[{"code":"Sx00-5976-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303642","type":"LOCAL"},{"code":"522599","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303642 = Hospital System Supply Identifier | 522599 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 3-4 14","code_information":[{"code":"Sx00-5976-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303644","type":"LOCAL"},{"code":"522601","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303644 = Hospital System Supply Identifier | 522601 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 3-4 20MM","code_information":[{"code":"Sx00-5976-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"181666","type":"LOCAL"},{"code":"453465","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 181666 = Hospital System Supply Identifier | 453465 = Lawson ID"}]},{"description":"IMP HIP ACET ARTC SURF","code_information":[{"code":"Sx00-5976-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326673","type":"LOCAL"},{"code":"408028","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326673 = Hospital System Supply Identifier | 408028 = Lawson ID"}]},{"description":"IMP HIP ACET ARTC SURF","code_information":[{"code":"Sx00-5976-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178792","type":"LOCAL"},{"code":"408027","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178792 = Hospital System Supply Identifier | 408027 = Lawson ID"}]},{"description":"IMP KNEE ANT CNSTRN YEL SZ17","code_information":[{"code":"Sx00-5976-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202257","type":"LOCAL"},{"code":"452355","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202257 = Hospital System Supply Identifier | 452355 = Lawson ID"}]},{"description":"IMP TIB NXGN ANT CONSTR SZ GRN","code_information":[{"code":"Sx00-5976-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329807","type":"LOCAL"},{"code":"379486","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329807 = Hospital System Supply Identifier | 379486 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 5-6 12","code_information":[{"code":"Sx00-5976-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303645","type":"LOCAL"},{"code":"522602","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303645 = Hospital System Supply Identifier | 522602 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 5-6 14","code_information":[{"code":"Sx00-5976-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303646","type":"LOCAL"},{"code":"522603","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303646 = Hospital System Supply Identifier | 522603 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 5-6 17","code_information":[{"code":"Sx00-5976-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303647","type":"LOCAL"},{"code":"522604","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303647 = Hospital System Supply Identifier | 522604 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 5-6 20","code_information":[{"code":"Sx00-5976-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303648","type":"LOCAL"},{"code":"522605","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303648 = Hospital System Supply Identifier | 522605 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN7-10 20","code_information":[{"code":"Sx00-5976-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303654","type":"LOCAL"},{"code":"522611","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303654 = Hospital System Supply Identifier | 522611 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN7-10 17","code_information":[{"code":"Sx00-5976-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303653","type":"LOCAL"},{"code":"522610","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303653 = Hospital System Supply Identifier | 522610 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN7-10 10","code_information":[{"code":"Sx00-5976-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303650","type":"LOCAL"},{"code":"522607","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303650 = Hospital System Supply Identifier | 522607 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN7-10 12","code_information":[{"code":"Sx00-5976-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303651","type":"LOCAL"},{"code":"522608","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303651 = Hospital System Supply Identifier | 522608 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN7-10 14","code_information":[{"code":"Sx00-5976-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303652","type":"LOCAL"},{"code":"522609","type":"LOCAL"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303652 = Hospital System Supply Identifier | 522609 = Lawson ID"}]},{"description":"BIT DRILL NEXGEN CEMENTED STEM","code_information":[{"code":"Sx00-5977-010","type":"CDM"},{"code":"272","type":"RC"},{"code":"449581","type":"LOCAL"},{"code":"313631","type":"LOCAL"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 449581 = Hospital System Supply Identifier | 313631 = Lawson ID"}]},{"description":"BIT DRILL 12.7MM NSTRL 5IN 1 CEMENT STEM SS KNEE TIBIA LCCK NEXGEN","code_information":[{"code":"Sx00-5977-010","type":"CDM"},{"code":"272","type":"RC"},{"code":"1090156","type":"LOCAL"},{"code":"S657329","type":"LOCAL"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":183.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1090156 = Hospital System Supply Identifier | S657329 = Lawson ID"}]},{"description":"GUIDE DRILL PTELA 26/29MM","code_information":[{"code":"Sx00-5979-001","type":"CDM"},{"code":"272","type":"RC"},{"code":"202050","type":"LOCAL"},{"code":"452142","type":"LOCAL"}],"standard_charges":[{"gross_charge":6423.9,"discounted_cash":2248.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202050 = Hospital System Supply Identifier | 452142 = Lawson ID"}]},{"description":"GUIDE DRILL PTELA 32/35MM","code_information":[{"code":"Sx00-5979-001","type":"CDM"},{"code":"272","type":"RC"},{"code":"202051","type":"LOCAL"},{"code":"452143","type":"LOCAL"}],"standard_charges":[{"gross_charge":1282.05,"discounted_cash":448.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202051 = Hospital System Supply Identifier | 452143 = Lawson ID"}]},{"description":"GUIDE DRILL PTELA 38/41MM","code_information":[{"code":"Sx00-5979-001","type":"CDM"},{"code":"272","type":"RC"},{"code":"202052","type":"LOCAL"},{"code":"452144","type":"LOCAL"}],"standard_charges":[{"gross_charge":945.0,"discounted_cash":330.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202052 = Hospital System Supply Identifier | 452144 = Lawson ID"}]},{"description":"REAMER PTELA W/PILOT DRL SZ 51","code_information":[{"code":"Sx00-5979-077","type":"CDM"},{"code":"272","type":"RC"},{"code":"303663","type":"LOCAL"},{"code":"522620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1766.45,"discounted_cash":618.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303663 = Hospital System Supply Identifier | 522620 = Lawson ID"}]},{"description":"REAMER PTELA W/PILOT DRL SZ 46","code_information":[{"code":"Sx00-5979-077","type":"CDM"},{"code":"272","type":"RC"},{"code":"303662","type":"LOCAL"},{"code":"522619","type":"LOCAL"}],"standard_charges":[{"gross_charge":1766.45,"discounted_cash":618.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303662 = Hospital System Supply Identifier | 522619 = Lawson ID"}]},{"description":"REAMER PTELA W/PILOT DRL SZ 41","code_information":[{"code":"Sx00-5979-077","type":"CDM"},{"code":"272","type":"RC"},{"code":"303661","type":"LOCAL"},{"code":"522618","type":"LOCAL"}],"standard_charges":[{"gross_charge":1766.45,"discounted_cash":618.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303661 = Hospital System Supply Identifier | 522618 = Lawson ID"}]},{"description":"REAMER PTELA W/PILOT DRL SZ 38","code_information":[{"code":"Sx00-5979-077","type":"CDM"},{"code":"272","type":"RC"},{"code":"303660","type":"LOCAL"},{"code":"522617","type":"LOCAL"}],"standard_charges":[{"gross_charge":1766.45,"discounted_cash":618.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303660 = Hospital System Supply Identifier | 522617 = Lawson ID"}]},{"description":"REAMER PTELA W/PILOT DRL SZ 32","code_information":[{"code":"Sx00-5979-077","type":"CDM"},{"code":"272","type":"RC"},{"code":"303658","type":"LOCAL"},{"code":"522615","type":"LOCAL"}],"standard_charges":[{"gross_charge":1766.45,"discounted_cash":618.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303658 = Hospital System Supply Identifier | 522615 = Lawson ID"}]},{"description":"REAMER PTELA W/PILOT DRL SZ 29","code_information":[{"code":"Sx00-5979-077","type":"CDM"},{"code":"272","type":"RC"},{"code":"303657","type":"LOCAL"},{"code":"522614","type":"LOCAL"}],"standard_charges":[{"gross_charge":1766.45,"discounted_cash":618.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303657 = Hospital System Supply Identifier | 522614 = Lawson ID"}]},{"description":"REAMER PTELA W/PILOT DRL SZ 26","code_information":[{"code":"Sx00-5979-077","type":"CDM"},{"code":"272","type":"RC"},{"code":"303656","type":"LOCAL"},{"code":"522613","type":"LOCAL"}],"standard_charges":[{"gross_charge":1766.45,"discounted_cash":618.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303656 = Hospital System Supply Identifier | 522613 = Lawson ID"}]},{"description":"REAMER PTELA W/PILOT DRL SZ 35","code_information":[{"code":"Sx00-5979-077","type":"CDM"},{"code":"272","type":"RC"},{"code":"303659","type":"LOCAL"},{"code":"522616","type":"LOCAL"}],"standard_charges":[{"gross_charge":1766.45,"discounted_cash":618.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303659 = Hospital System Supply Identifier | 522616 = Lawson ID"}]},{"description":"BLADE PAT REAM PILOT-H 29MM","code_information":[{"code":"Sx00-5979-095","type":"CDM"},{"code":"272","type":"RC"},{"code":"325030","type":"LOCAL"},{"code":"333600","type":"LOCAL"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":208.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325030 = Hospital System Supply Identifier | 333600 = Lawson ID"}]},{"description":"BLADE REAM PTELA W/PIL HL SZ26","code_information":[{"code":"Sx00-5979-095","type":"CDM"},{"code":"272","type":"RC"},{"code":"303664","type":"LOCAL"},{"code":"522621","type":"LOCAL"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":208.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 303664 = Hospital System Supply Identifier | 522621 = Lawson ID"}]},{"description":"BLADE PAT REAM PILOT-H 32MM","code_information":[{"code":"Sx00-5979-095","type":"CDM"},{"code":"272","type":"RC"},{"code":"194243","type":"LOCAL"},{"code":"333601","type":"LOCAL"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":208.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194243 = Hospital System Supply Identifier | 333601 = Lawson ID"}]},{"description":"REAMER PTELA 51MM","code_information":[{"code":"Sx00-5979-095","type":"CDM"},{"code":"272","type":"RC"},{"code":"145874","type":"LOCAL"},{"code":"255263","type":"LOCAL"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":208.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145874 = Hospital System Supply Identifier | 255263 = Lawson ID"}]},{"description":"REAMER PTELA 46MM","code_information":[{"code":"Sx00-5979-095","type":"CDM"},{"code":"272","type":"RC"},{"code":"145716","type":"LOCAL"},{"code":"232505","type":"LOCAL"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":208.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145716 = Hospital System Supply Identifier | 232505 = Lawson ID"}]},{"description":"REAMER PTELA 38MM","code_information":[{"code":"Sx00-5979-095","type":"CDM"},{"code":"272","type":"RC"},{"code":"149149","type":"LOCAL"},{"code":"236452","type":"LOCAL"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":208.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 149149 = Hospital System Supply Identifier | 236452 = Lawson ID"}]},{"description":"REAMER PTELA 41MM","code_information":[{"code":"Sx00-5979-095","type":"CDM"},{"code":"272","type":"RC"},{"code":"145710","type":"LOCAL"},{"code":"232163","type":"LOCAL"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":208.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145710 = Hospital System Supply Identifier | 232163 = Lawson ID"}]},{"description":"REAMER PTELA 35MM","code_information":[{"code":"Sx00-5979-095","type":"CDM"},{"code":"272","type":"RC"},{"code":"149913","type":"LOCAL"},{"code":"237469","type":"LOCAL"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":208.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 149913 = Hospital System Supply Identifier | 237469 = Lawson ID"}]},{"description":"PLATE TIBIA SIZE 1 5980-27-01","code_information":[{"code":"Sx00-5980-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"145627","type":"LOCAL"},{"code":"202631","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145627 = Hospital System Supply Identifier | 202631 = Lawson ID"}]},{"description":"IMP TIB BSPLT CRUC NXGN SZ2","code_information":[{"code":"Sx00-5980-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145646","type":"LOCAL"},{"code":"205287","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145646 = Hospital System Supply Identifier | 205287 = Lawson ID"}]},{"description":"COMPONENT STEM TIBAL PLATE 4","code_information":[{"code":"Sx00-5980-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145614","type":"LOCAL"},{"code":"145758","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145614 = Hospital System Supply Identifier | 145758 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP STEM PLT 3","code_information":[{"code":"Sx00-5980-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145625","type":"LOCAL"},{"code":"202392","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145625 = Hospital System Supply Identifier | 202392 = Lawson ID"}]},{"description":"IMP TIB BSPLT POST NXGN SZ5","code_information":[{"code":"Sx00-5980-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145626","type":"LOCAL"},{"code":"202629","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145626 = Hospital System Supply Identifier | 202629 = Lawson ID"}]},{"description":"COMPONENT STEM TIBIAL PLATE 6","code_information":[{"code":"Sx00-5980-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145645","type":"LOCAL"},{"code":"204692","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145645 = Hospital System Supply Identifier | 204692 = Lawson ID"}]},{"description":"COMPONENT STEM TIBIAL PLATE 9","code_information":[{"code":"Sx00-5980-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"191988","type":"LOCAL"},{"code":"205017","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 191988 = Hospital System Supply Identifier | 205017 = Lawson ID"}]},{"description":"COMPONENT STEM TIBIAL PLATE 8","code_information":[{"code":"Sx00-5980-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167758","type":"LOCAL"},{"code":"203518","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 167758 = Hospital System Supply Identifier | 203518 = Lawson ID"}]},{"description":"COMPONENT STEM TIBIAL PLATE 10","code_information":[{"code":"Sx00-5980-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"191964","type":"LOCAL"},{"code":"204223","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 191964 = Hospital System Supply Identifier | 204223 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN LT SZ7","code_information":[{"code":"Sx00-5980-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167952","type":"LOCAL"},{"code":"204693","type":"LOCAL"}],"standard_charges":[{"gross_charge":3360.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 167952 = Hospital System Supply Identifier | 204693 = Lawson ID"}]},{"description":"SCREW REPL LOK F/STM EXT","code_information":[{"code":"Sx00-5980-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"171792","type":"LOCAL"},{"code":"439195","type":"LOCAL"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":134.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 171792 = Hospital System Supply Identifier | 439195 = Lawson ID"}]},{"description":"TRIAL KNEE 6 STD 74X50GRN STRI","code_information":[{"code":"Sx00-5981-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"929715","type":"LOCAL"},{"code":"813952","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 929715 = Hospital System Supply Identifier | 813952 = Lawson ID"}]},{"description":"SCREW HEADED NEXGEN 00598304033 SS 33MM","code_information":[{"code":"Sx00-5983-040","type":"CDM"},{"code":"272","type":"RC"},{"code":"1170808","type":"LOCAL"},{"code":"1004404","type":"LOCAL"}],"standard_charges":[{"gross_charge":318.15,"discounted_cash":111.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1170808 = Hospital System Supply Identifier | 1004404 = Lawson ID"}]},{"description":"SCREW GUIDE 48MM STRL HEXAGON HEAD MIS QUAD-SPARING","code_information":[{"code":"Sx00-5983-040","type":"CDM"},{"code":"272","type":"RC"},{"code":"1103504","type":"LOCAL"},{"code":"S281814","type":"LOCAL"}],"standard_charges":[{"gross_charge":318.15,"discounted_cash":111.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1103504 = Hospital System Supply Identifier | S281814 = Lawson ID"}]},{"description":"GUIDE SURGICAL 27MM HEX HEAD SCREW","code_information":[{"code":"Sx00-5983-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"202219","type":"LOCAL"},{"code":"452317","type":"LOCAL"}],"standard_charges":[{"gross_charge":318.15,"discounted_cash":111.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202219 = Hospital System Supply Identifier | 452317 = Lawson ID"}]},{"description":"SCREW HDLSS MIS 48MM","code_information":[{"code":"Sx00-5983-041","type":"CDM"},{"code":"272","type":"RC"},{"code":"662126","type":"LOCAL"},{"code":"360630","type":"LOCAL"}],"standard_charges":[{"gross_charge":318.15,"discounted_cash":111.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662126 = Hospital System Supply Identifier | 360630 = Lawson ID"}]},{"description":"INST RETRAC COLLATERAL","code_information":[{"code":"Sx00-5983-082","type":"CDM"},{"code":"272","type":"RC"},{"code":"202106","type":"LOCAL"},{"code":"452202","type":"LOCAL"}],"standard_charges":[{"gross_charge":1195.42,"discounted_cash":418.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202106 = Hospital System Supply Identifier | 452202 = Lawson ID"}]},{"description":"BIT DRILL 18MM NSTRL STEM SS KNEE FEMUR NEXGEN","code_information":[{"code":"Sx00-5987-010","type":"CDM"},{"code":"272","type":"RC"},{"code":"1090165","type":"LOCAL"},{"code":"S657330","type":"LOCAL"}],"standard_charges":[{"gross_charge":665.0,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1090165 = Hospital System Supply Identifier | S657330 = Lawson ID"}]},{"description":"SCRDRVR HEX 2MM","code_information":[{"code":"Sx00-5987-071","type":"CDM"},{"code":"272","type":"RC"},{"code":"194001","type":"LOCAL"},{"code":"323762","type":"LOCAL"}],"standard_charges":[{"gross_charge":335.85,"discounted_cash":117.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194001 = Hospital System Supply Identifier | 323762 = Lawson ID"}]},{"description":"NUT LOCK OFFSET NSTRL REVISION STEM SS KNEE FEMUR LCCK NEXGEN","code_information":[{"code":"Sx00-5987-080","type":"CDM"},{"code":"272","type":"RC"},{"code":"1099592","type":"LOCAL"},{"code":"S651505","type":"LOCAL"}],"standard_charges":[{"gross_charge":297.5,"discounted_cash":104.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1099592 = Hospital System Supply Identifier | S651505 = Lawson ID"}]},{"description":"TRIAL KNEE SHORT 6MM 3.5MM NSTRL AUGMENT SCREW HEXAGONAL HEAD FEMORAL PROVISIONAL NEXGEN","code_information":[{"code":"Sx00-5987-085","type":"CDM"},{"code":"272","type":"RC"},{"code":"662252","type":"LOCAL"},{"code":"446540","type":"LOCAL"}],"standard_charges":[{"gross_charge":612.5,"discounted_cash":214.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 662252 = Hospital System Supply Identifier | 446540 = Lawson ID"}]},{"description":"SCRDRVR HEX FEM AUG 3.5MM","code_information":[{"code":"Sx00-5987-089","type":"CDM"},{"code":"272","type":"RC"},{"code":"202339","type":"LOCAL"},{"code":"452438","type":"LOCAL"}],"standard_charges":[{"gross_charge":857.5,"discounted_cash":300.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202339 = Hospital System Supply Identifier | 452438 = Lawson ID"}]},{"description":"IMP AUG DST NXGN SZ C/D 10MM","code_information":[{"code":"Sx00-5987-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202038","type":"LOCAL"},{"code":"452130","type":"LOCAL"}],"standard_charges":[{"gross_charge":507.5,"discounted_cash":177.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202038 = Hospital System Supply Identifier | 452130 = Lawson ID"}]},{"description":"IMP AUG DST NXGN SZ C/D 5MM","code_information":[{"code":"Sx00-5987-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202039","type":"LOCAL"},{"code":"452131","type":"LOCAL"}],"standard_charges":[{"gross_charge":507.5,"discounted_cash":177.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202039 = Hospital System Supply Identifier | 452131 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 1 20","code_information":[{"code":"Sx00-5988-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322793","type":"LOCAL"},{"code":"536008","type":"LOCAL"}],"standard_charges":[{"gross_charge":4947.6,"discounted_cash":1731.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322793 = Hospital System Supply Identifier | 536008 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 1 15","code_information":[{"code":"Sx00-5988-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322792","type":"LOCAL"},{"code":"536007","type":"LOCAL"}],"standard_charges":[{"gross_charge":4621.75,"discounted_cash":1617.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322792 = Hospital System Supply Identifier | 536007 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ1 15","code_information":[{"code":"Sx00-5988-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322790","type":"LOCAL"},{"code":"536005","type":"LOCAL"}],"standard_charges":[{"gross_charge":4621.75,"discounted_cash":1617.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322790 = Hospital System Supply Identifier | 536005 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 1 20","code_information":[{"code":"Sx00-5988-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322791","type":"LOCAL"},{"code":"536006","type":"LOCAL"}],"standard_charges":[{"gross_charge":4947.6,"discounted_cash":1731.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322791 = Hospital System Supply Identifier | 536006 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG NXGN SZ1 5","code_information":[{"code":"Sx00-5988-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322788","type":"LOCAL"},{"code":"536003","type":"LOCAL"}],"standard_charges":[{"gross_charge":4671.62,"discounted_cash":1635.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322788 = Hospital System Supply Identifier | 536003 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN FULL SZ1 10","code_information":[{"code":"Sx00-5988-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321979","type":"LOCAL"},{"code":"535193","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 321979 = Hospital System Supply Identifier | 535193 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG NXGN SZ1 10","code_information":[{"code":"Sx00-5988-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322789","type":"LOCAL"},{"code":"536004","type":"LOCAL"}],"standard_charges":[{"gross_charge":4671.62,"discounted_cash":1635.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322789 = Hospital System Supply Identifier | 536004 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 2 20","code_information":[{"code":"Sx00-5988-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322795","type":"LOCAL"},{"code":"536010","type":"LOCAL"}],"standard_charges":[{"gross_charge":4947.6,"discounted_cash":1731.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322795 = Hospital System Supply Identifier | 536010 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG SZ2 15MM","code_information":[{"code":"Sx00-5988-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327308","type":"LOCAL"},{"code":"416877","type":"LOCAL"}],"standard_charges":[{"gross_charge":4621.75,"discounted_cash":1617.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 327308 = Hospital System Supply Identifier | 416877 = Lawson ID"}]},{"description":"IMP TIB BLCK NXGN SZ2 10MM","code_information":[{"code":"Sx00-5988-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198157","type":"LOCAL"},{"code":"443397","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 198157 = Hospital System Supply Identifier | 443397 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN BLCK SZ 2 5","code_information":[{"code":"Sx00-5988-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321984","type":"LOCAL"},{"code":"535198","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 321984 = Hospital System Supply Identifier | 535198 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN BLCK SZ 2 10","code_information":[{"code":"Sx00-5988-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321985","type":"LOCAL"},{"code":"535199","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 321985 = Hospital System Supply Identifier | 535199 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 2 15","code_information":[{"code":"Sx00-5988-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322794","type":"LOCAL"},{"code":"536009","type":"LOCAL"}],"standard_charges":[{"gross_charge":4621.75,"discounted_cash":1617.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322794 = Hospital System Supply Identifier | 536009 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 2 20","code_information":[{"code":"Sx00-5988-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322796","type":"LOCAL"},{"code":"536011","type":"LOCAL"}],"standard_charges":[{"gross_charge":4947.6,"discounted_cash":1731.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322796 = Hospital System Supply Identifier | 536011 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 3 20","code_information":[{"code":"Sx00-5988-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322798","type":"LOCAL"},{"code":"536013","type":"LOCAL"}],"standard_charges":[{"gross_charge":4947.6,"discounted_cash":1731.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322798 = Hospital System Supply Identifier | 536013 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 3 15","code_information":[{"code":"Sx00-5988-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322797","type":"LOCAL"},{"code":"536012","type":"LOCAL"}],"standard_charges":[{"gross_charge":4621.75,"discounted_cash":1617.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322797 = Hospital System Supply Identifier | 536012 = Lawson ID"}]},{"description":"IMP TIB PLT WDG PRECT NXGN SZ3","code_information":[{"code":"Sx00-5988-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321986","type":"LOCAL"},{"code":"535200","type":"LOCAL"}],"standard_charges":[{"gross_charge":8800.0,"discounted_cash":3080.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 321986 = Hospital System Supply Identifier | 535200 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 3 15","code_information":[{"code":"Sx00-5988-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322799","type":"LOCAL"},{"code":"536014","type":"LOCAL"}],"standard_charges":[{"gross_charge":4621.75,"discounted_cash":1617.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322799 = Hospital System Supply Identifier | 536014 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ3 10MM","code_information":[{"code":"Sx00-5988-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192127","type":"LOCAL"},{"code":"223392","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 192127 = Hospital System Supply Identifier | 223392 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ3 5MM","code_information":[{"code":"Sx00-5988-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146878","type":"LOCAL"},{"code":"223391","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146878 = Hospital System Supply Identifier | 223391 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN SZ3 10MM","code_information":[{"code":"Sx00-5988-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196573","type":"LOCAL"},{"code":"412556","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 196573 = Hospital System Supply Identifier | 412556 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 3 20","code_information":[{"code":"Sx00-5988-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322800","type":"LOCAL"},{"code":"536015","type":"LOCAL"}],"standard_charges":[{"gross_charge":4947.6,"discounted_cash":1731.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322800 = Hospital System Supply Identifier | 536015 = Lawson ID"}]},{"description":"IMP TIB PLT WDG PRECT NXGN SZ4","code_information":[{"code":"Sx00-5988-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321991","type":"LOCAL"},{"code":"535205","type":"LOCAL"}],"standard_charges":[{"gross_charge":8800.0,"discounted_cash":3080.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 321991 = Hospital System Supply Identifier | 535205 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 4 20","code_information":[{"code":"Sx00-5988-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322802","type":"LOCAL"},{"code":"536017","type":"LOCAL"}],"standard_charges":[{"gross_charge":4947.6,"discounted_cash":1731.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322802 = Hospital System Supply Identifier | 536017 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG SZ4 15MM","code_information":[{"code":"Sx00-5988-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326297","type":"LOCAL"},{"code":"395499","type":"LOCAL"}],"standard_charges":[{"gross_charge":4621.75,"discounted_cash":1617.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326297 = Hospital System Supply Identifier | 395499 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 4 20","code_information":[{"code":"Sx00-5988-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322801","type":"LOCAL"},{"code":"536016","type":"LOCAL"}],"standard_charges":[{"gross_charge":4947.6,"discounted_cash":1731.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322801 = Hospital System Supply Identifier | 536016 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ4 15MM","code_information":[{"code":"Sx00-5988-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329381","type":"LOCAL"},{"code":"324178","type":"LOCAL"}],"standard_charges":[{"gross_charge":4621.75,"discounted_cash":1617.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329381 = Hospital System Supply Identifier | 324178 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ4 10MM","code_information":[{"code":"Sx00-5988-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329030","type":"LOCAL"},{"code":"223394","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329030 = Hospital System Supply Identifier | 223394 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ4 5MM","code_information":[{"code":"Sx00-5988-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329029","type":"LOCAL"},{"code":"223393","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329029 = Hospital System Supply Identifier | 223393 = Lawson ID"}]},{"description":"IMP TIB STEM NXGN PRE SZ4 10MM","code_information":[{"code":"Sx00-5988-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194723","type":"LOCAL"},{"code":"347385","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 194723 = Hospital System Supply Identifier | 347385 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 5 20","code_information":[{"code":"Sx00-5988-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322804","type":"LOCAL"},{"code":"536019","type":"LOCAL"}],"standard_charges":[{"gross_charge":4947.6,"discounted_cash":1731.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322804 = Hospital System Supply Identifier | 536019 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG SZ5 15MM","code_information":[{"code":"Sx00-5988-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326830","type":"LOCAL"},{"code":"402005","type":"LOCAL"}],"standard_charges":[{"gross_charge":4621.75,"discounted_cash":1617.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326830 = Hospital System Supply Identifier | 402005 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 5 15","code_information":[{"code":"Sx00-5988-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322803","type":"LOCAL"},{"code":"536018","type":"LOCAL"}],"standard_charges":[{"gross_charge":4621.75,"discounted_cash":1617.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322803 = Hospital System Supply Identifier | 536018 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG SZ5 20MM","code_information":[{"code":"Sx00-5988-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326829","type":"LOCAL"},{"code":"402004","type":"LOCAL"}],"standard_charges":[{"gross_charge":4947.6,"discounted_cash":1731.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326829 = Hospital System Supply Identifier | 402004 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ5 5MM","code_information":[{"code":"Sx00-5988-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329031","type":"LOCAL"},{"code":"223395","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329031 = Hospital System Supply Identifier | 223395 = Lawson ID"}]},{"description":"IMP TIB BSPLT MOD NXGN SZ5","code_information":[{"code":"Sx00-5988-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329380","type":"LOCAL"},{"code":"324173","type":"LOCAL"}],"standard_charges":[{"gross_charge":8800.0,"discounted_cash":3080.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329380 = Hospital System Supply Identifier | 324173 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ5 10MM","code_information":[{"code":"Sx00-5988-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178245","type":"LOCAL"},{"code":"223396","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 178245 = Hospital System Supply Identifier | 223396 = Lawson ID"}]},{"description":"IMP TIB STEM NXGN PRE SZ5 10MM","code_information":[{"code":"Sx00-5988-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329382","type":"LOCAL"},{"code":"324179","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329382 = Hospital System Supply Identifier | 324179 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ6 5MM","code_information":[{"code":"Sx00-5988-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329032","type":"LOCAL"},{"code":"223397","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329032 = Hospital System Supply Identifier | 223397 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ6 10MM","code_information":[{"code":"Sx00-5988-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329033","type":"LOCAL"},{"code":"223398","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329033 = Hospital System Supply Identifier | 223398 = Lawson ID"}]},{"description":"TIBIAL COMP STEMMED SZ 6","code_information":[{"code":"Sx00-5988-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325957","type":"LOCAL"},{"code":"374594","type":"LOCAL"}],"standard_charges":[{"gross_charge":8800.0,"discounted_cash":3080.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 325957 = Hospital System Supply Identifier | 374594 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG SZ6 10MM","code_information":[{"code":"Sx00-5988-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326831","type":"LOCAL"},{"code":"402006","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 326831 = Hospital System Supply Identifier | 402006 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 6 15","code_information":[{"code":"Sx00-5988-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322805","type":"LOCAL"},{"code":"536020","type":"LOCAL"}],"standard_charges":[{"gross_charge":4621.75,"discounted_cash":1617.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322805 = Hospital System Supply Identifier | 536020 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 6 20","code_information":[{"code":"Sx00-5988-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322806","type":"LOCAL"},{"code":"536021","type":"LOCAL"}],"standard_charges":[{"gross_charge":4947.6,"discounted_cash":1731.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322806 = Hospital System Supply Identifier | 536021 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 6 15","code_information":[{"code":"Sx00-5988-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322807","type":"LOCAL"},{"code":"536022","type":"LOCAL"}],"standard_charges":[{"gross_charge":4621.75,"discounted_cash":1617.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322807 = Hospital System Supply Identifier | 536022 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 6 20","code_information":[{"code":"Sx00-5988-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322808","type":"LOCAL"},{"code":"536023","type":"LOCAL"}],"standard_charges":[{"gross_charge":4947.6,"discounted_cash":1731.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322808 = Hospital System Supply Identifier | 536023 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 7 20","code_information":[{"code":"Sx00-5988-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322812","type":"LOCAL"},{"code":"536027","type":"LOCAL"}],"standard_charges":[{"gross_charge":5045.25,"discounted_cash":1765.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322812 = Hospital System Supply Identifier | 536027 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 7 15","code_information":[{"code":"Sx00-5988-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322811","type":"LOCAL"},{"code":"536026","type":"LOCAL"}],"standard_charges":[{"gross_charge":4621.75,"discounted_cash":1617.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322811 = Hospital System Supply Identifier | 536026 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 7 20","code_information":[{"code":"Sx00-5988-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322810","type":"LOCAL"},{"code":"536025","type":"LOCAL"}],"standard_charges":[{"gross_charge":5045.25,"discounted_cash":1765.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322810 = Hospital System Supply Identifier | 536025 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 7 15","code_information":[{"code":"Sx00-5988-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322809","type":"LOCAL"},{"code":"536024","type":"LOCAL"}],"standard_charges":[{"gross_charge":4621.75,"discounted_cash":1617.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322809 = Hospital System Supply Identifier | 536024 = Lawson ID"}]},{"description":"IMP TIB STEM NXGN PRE SZ7 10MM","code_information":[{"code":"Sx00-5988-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329383","type":"LOCAL"},{"code":"324181","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329383 = Hospital System Supply Identifier | 324181 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ7 10MM","code_information":[{"code":"Sx00-5988-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329035","type":"LOCAL"},{"code":"223400","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329035 = Hospital System Supply Identifier | 223400 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ7 5MM","code_information":[{"code":"Sx00-5988-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329034","type":"LOCAL"},{"code":"223399","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329034 = Hospital System Supply Identifier | 223399 = Lawson ID"}]},{"description":"IMP KNEE TIB PLT WDG BL/STR SZ","code_information":[{"code":"Sx00-5988-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202326","type":"LOCAL"},{"code":"452424","type":"LOCAL"}],"standard_charges":[{"gross_charge":8800.0,"discounted_cash":3080.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 202326 = Hospital System Supply Identifier | 452424 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 8 15","code_information":[{"code":"Sx00-5988-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322813","type":"LOCAL"},{"code":"536028","type":"LOCAL"}],"standard_charges":[{"gross_charge":4405.62,"discounted_cash":1541.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322813 = Hospital System Supply Identifier | 536028 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ8 5MM","code_information":[{"code":"Sx00-5988-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329036","type":"LOCAL"},{"code":"223401","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329036 = Hospital System Supply Identifier | 223401 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ8 10MM","code_information":[{"code":"Sx00-5988-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329037","type":"LOCAL"},{"code":"223402","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329037 = Hospital System Supply Identifier | 223402 = Lawson ID"}]},{"description":"IMP TIB PLT WDG PRECT NXGN SZ8","code_information":[{"code":"Sx00-5988-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322008","type":"LOCAL"},{"code":"535222","type":"LOCAL"}],"standard_charges":[{"gross_charge":8800.0,"discounted_cash":3080.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322008 = Hospital System Supply Identifier | 535222 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN FULL SZ8 10","code_information":[{"code":"Sx00-5988-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322009","type":"LOCAL"},{"code":"535223","type":"LOCAL"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322009 = Hospital System Supply Identifier | 535223 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 8 20","code_information":[{"code":"Sx00-5988-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322814","type":"LOCAL"},{"code":"536029","type":"LOCAL"}],"standard_charges":[{"gross_charge":5045.25,"discounted_cash":1765.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322814 = Hospital System Supply Identifier | 536029 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 8 15","code_information":[{"code":"Sx00-5988-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322815","type":"LOCAL"},{"code":"536030","type":"LOCAL"}],"standard_charges":[{"gross_charge":4671.62,"discounted_cash":1635.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322815 = Hospital System Supply Identifier | 536030 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 8 20","code_information":[{"code":"Sx00-5988-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322816","type":"LOCAL"},{"code":"536031","type":"LOCAL"}],"standard_charges":[{"gross_charge":5045.25,"discounted_cash":1765.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322816 = Hospital System Supply Identifier | 536031 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 20MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329039","type":"LOCAL"},{"code":"223412","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329039 = Hospital System Supply Identifier | 223412 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 18MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146881","type":"LOCAL"},{"code":"223411","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146881 = Hospital System Supply Identifier | 223411 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM NXGN STD 24M","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323477","type":"LOCAL"},{"code":"223414","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 323477 = Hospital System Supply Identifier | 223414 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 22MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329040","type":"LOCAL"},{"code":"223413","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329040 = Hospital System Supply Identifier | 223413 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 17MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169563","type":"LOCAL"},{"code":"223410","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 169563 = Hospital System Supply Identifier | 223410 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 16MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329038","type":"LOCAL"},{"code":"223409","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329038 = Hospital System Supply Identifier | 223409 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 14MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146880","type":"LOCAL"},{"code":"223407","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146880 = Hospital System Supply Identifier | 223407 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 13MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146879","type":"LOCAL"},{"code":"223406","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 146879 = Hospital System Supply Identifier | 223406 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 12MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192130","type":"LOCAL"},{"code":"223405","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 192130 = Hospital System Supply Identifier | 223405 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 11MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192129","type":"LOCAL"},{"code":"223404","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 192129 = Hospital System Supply Identifier | 223404 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 10MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192128","type":"LOCAL"},{"code":"223403","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 192128 = Hospital System Supply Identifier | 223403 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 15MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169562","type":"LOCAL"},{"code":"223408","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 169562 = Hospital System Supply Identifier | 223408 = Lawson ID"}]},{"description":"IMP TIB STEM EXT STR 16X200MM","code_information":[{"code":"Sx00-5988-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329148","type":"LOCAL"},{"code":"258418","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329148 = Hospital System Supply Identifier | 258418 = Lawson ID"}]},{"description":"IMP TIB STEM EXT STR 12X200MM","code_information":[{"code":"Sx00-5988-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329145","type":"LOCAL"},{"code":"258414","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329145 = Hospital System Supply Identifier | 258414 = Lawson ID"}]},{"description":"IMP TIB STEM EXT STR 13X200MM","code_information":[{"code":"Sx00-5988-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329146","type":"LOCAL"},{"code":"258415","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329146 = Hospital System Supply Identifier | 258415 = Lawson ID"}]},{"description":"IMP TIB STEM EXT STR 14X200MM","code_information":[{"code":"Sx00-5988-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193238","type":"LOCAL"},{"code":"258416","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 193238 = Hospital System Supply Identifier | 258416 = Lawson ID"}]},{"description":"IMP TIB STEM EXT STR 15X200MM","code_information":[{"code":"Sx00-5988-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329147","type":"LOCAL"},{"code":"258417","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329147 = Hospital System Supply Identifier | 258417 = Lawson ID"}]},{"description":"IMP TIB STEM EXT STR 17X200MM","code_information":[{"code":"Sx00-5988-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329149","type":"LOCAL"},{"code":"258419","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329149 = Hospital System Supply Identifier | 258419 = Lawson ID"}]},{"description":"IMP TIB STEM EXT STR 18X200MM","code_information":[{"code":"Sx00-5988-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329150","type":"LOCAL"},{"code":"258420","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329150 = Hospital System Supply Identifier | 258420 = Lawson ID"}]},{"description":"IMP TIB STEM EXT STR 12.7X300","code_information":[{"code":"Sx00-5988-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"330570","type":"LOCAL"},{"code":"462721","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 330570 = Hospital System Supply Identifier | 462721 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 15X30MM","code_information":[{"code":"Sx00-5988-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145671","type":"LOCAL"},{"code":"223555","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145671 = Hospital System Supply Identifier | 223555 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 24X120MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322021","type":"LOCAL"},{"code":"535235","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322021 = Hospital System Supply Identifier | 535235 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 20X120MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322020","type":"LOCAL"},{"code":"535234","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322020 = Hospital System Supply Identifier | 535234 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 16X120MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322017","type":"LOCAL"},{"code":"535231","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322017 = Hospital System Supply Identifier | 535231 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 19X120MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322019","type":"LOCAL"},{"code":"535233","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322019 = Hospital System Supply Identifier | 535233 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 18X120MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322018","type":"LOCAL"},{"code":"535232","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322018 = Hospital System Supply Identifier | 535232 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 15X120MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322016","type":"LOCAL"},{"code":"535230","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322016 = Hospital System Supply Identifier | 535230 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 12X77MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329385","type":"LOCAL"},{"code":"324192","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329385 = Hospital System Supply Identifier | 324192 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 22X75MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329389","type":"LOCAL"},{"code":"324196","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329389 = Hospital System Supply Identifier | 324196 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 17X25MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329388","type":"LOCAL"},{"code":"324195","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329388 = Hospital System Supply Identifier | 324195 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 14X75MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329387","type":"LOCAL"},{"code":"324194","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329387 = Hospital System Supply Identifier | 324194 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 13X75MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329386","type":"LOCAL"},{"code":"324193","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329386 = Hospital System Supply Identifier | 324193 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 1X75MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329384","type":"LOCAL"},{"code":"324191","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329384 = Hospital System Supply Identifier | 324191 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 10X120MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322015","type":"LOCAL"},{"code":"535229","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322015 = Hospital System Supply Identifier | 535229 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 14X175MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322025","type":"LOCAL"},{"code":"535239","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322025 = Hospital System Supply Identifier | 535239 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 15X175MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322026","type":"LOCAL"},{"code":"535240","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322026 = Hospital System Supply Identifier | 535240 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 12X175MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322024","type":"LOCAL"},{"code":"535238","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322024 = Hospital System Supply Identifier | 535238 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 24X175MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322029","type":"LOCAL"},{"code":"535243","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322029 = Hospital System Supply Identifier | 535243 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 22X175MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322028","type":"LOCAL"},{"code":"535242","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322028 = Hospital System Supply Identifier | 535242 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 11X175MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322023","type":"LOCAL"},{"code":"535237","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322023 = Hospital System Supply Identifier | 535237 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 16X175MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322027","type":"LOCAL"},{"code":"535241","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322027 = Hospital System Supply Identifier | 535241 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 19X130MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329760","type":"LOCAL"},{"code":"363975","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329760 = Hospital System Supply Identifier | 363975 = Lawson ID"}]},{"description":"IMP TIB STEM EXT STR 20X130MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329393","type":"LOCAL"},{"code":"324200","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329393 = Hospital System Supply Identifier | 324200 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 18X130MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329392","type":"LOCAL"},{"code":"324199","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329392 = Hospital System Supply Identifier | 324199 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 10X175MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322022","type":"LOCAL"},{"code":"535236","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322022 = Hospital System Supply Identifier | 535236 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 17X175MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329391","type":"LOCAL"},{"code":"324198","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329391 = Hospital System Supply Identifier | 324198 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 13X175MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329390","type":"LOCAL"},{"code":"324197","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329390 = Hospital System Supply Identifier | 324197 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 13X75MM","code_information":[{"code":"Sx00-5988-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322030","type":"LOCAL"},{"code":"535244","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322030 = Hospital System Supply Identifier | 535244 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 13X105MM","code_information":[{"code":"Sx00-5988-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322031","type":"LOCAL"},{"code":"535245","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322031 = Hospital System Supply Identifier | 535245 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 13X145MM","code_information":[{"code":"Sx00-5988-019","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322032","type":"LOCAL"},{"code":"535246","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322032 = Hospital System Supply Identifier | 535246 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN OFF 18MM","code_information":[{"code":"Sx00-5988-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329044","type":"LOCAL"},{"code":"223554","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329044 = Hospital System Supply Identifier | 223554 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN OFF 17MM","code_information":[{"code":"Sx00-5988-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329043","type":"LOCAL"},{"code":"223553","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329043 = Hospital System Supply Identifier | 223553 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN OFF 16MM","code_information":[{"code":"Sx00-5988-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329042","type":"LOCAL"},{"code":"223552","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329042 = Hospital System Supply Identifier | 223552 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN OFF 15MM","code_information":[{"code":"Sx00-5988-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192133","type":"LOCAL"},{"code":"223551","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 192133 = Hospital System Supply Identifier | 223551 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN OFF 11MM","code_information":[{"code":"Sx00-5988-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192131","type":"LOCAL"},{"code":"223547","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 192131 = Hospital System Supply Identifier | 223547 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN OFF 13MM","code_information":[{"code":"Sx00-5988-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329041","type":"LOCAL"},{"code":"223549","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329041 = Hospital System Supply Identifier | 223549 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN OFF 12MM","code_information":[{"code":"Sx00-5988-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145670","type":"LOCAL"},{"code":"223548","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 145670 = Hospital System Supply Identifier | 223548 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN OFF 14MM","code_information":[{"code":"Sx00-5988-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192132","type":"LOCAL"},{"code":"223550","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 192132 = Hospital System Supply Identifier | 223550 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN SZ17","code_information":[{"code":"Sx00-5988-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329047","type":"LOCAL"},{"code":"228916","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329047 = Hospital System Supply Identifier | 228916 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN SZ18","code_information":[{"code":"Sx00-5988-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329048","type":"LOCAL"},{"code":"228917","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329048 = Hospital System Supply Identifier | 228917 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN SZ16","code_information":[{"code":"Sx00-5988-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169565","type":"LOCAL"},{"code":"228915","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 169565 = Hospital System Supply Identifier | 228915 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN SZ12","code_information":[{"code":"Sx00-5988-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192154","type":"LOCAL"},{"code":"228911","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 192154 = Hospital System Supply Identifier | 228911 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN SZ14","code_information":[{"code":"Sx00-5988-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329046","type":"LOCAL"},{"code":"228913","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329046 = Hospital System Supply Identifier | 228913 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN SZ13","code_information":[{"code":"Sx00-5988-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329045","type":"LOCAL"},{"code":"228912","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 329045 = Hospital System Supply Identifier | 228912 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN SZ15","code_information":[{"code":"Sx00-5988-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"171765","type":"LOCAL"},{"code":"228914","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 171765 = Hospital System Supply Identifier | 228914 = Lawson ID"}]},{"description":"SCREW SET FEM NXGN","code_information":[{"code":"Sx00-5988-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"322033","type":"LOCAL"},{"code":"535247","type":"LOCAL"}],"standard_charges":[{"gross_charge":507.5,"discounted_cash":177.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322033 = Hospital System Supply Identifier | 535247 = Lawson ID"}]},{"description":"SCREW TIB WDG ATTCH NXGN","code_information":[{"code":"Sx00-5988-091","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"322034","type":"LOCAL"},{"code":"535248","type":"LOCAL"}],"standard_charges":[{"gross_charge":507.5,"discounted_cash":177.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322034 = Hospital System Supply Identifier | 535248 = Lawson ID"}]},{"description":"SCREW FEM AUG NXGN","code_information":[{"code":"Sx00-5988-092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"322035","type":"LOCAL"},{"code":"535249","type":"LOCAL"}],"standard_charges":[{"gross_charge":507.5,"discounted_cash":177.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 322035 = Hospital System Supply Identifier | 535249 = Lawson ID"}]},{"description":"BLOCK AUGMENTATION 1 FULL 10MM TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1090381","type":"LOCAL"},{"code":"S652392","type":"LOCAL"}],"standard_charges":[{"gross_charge":822.5,"discounted_cash":287.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1090381 = Hospital System Supply Identifier | S652392 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 2 20MM NSTRL REVISION ROTATE HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089628","type":"LOCAL"},{"code":"S652409","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089628 = Hospital System Supply Identifier | S652409 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 2 15MM NSTRL REVISION ROTATE HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089626","type":"LOCAL"},{"code":"S652408","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089626 = Hospital System Supply Identifier | S652408 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 2 10MM NSTRL REVISION ROTATE HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089624","type":"LOCAL"},{"code":"S652407","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089624 = Hospital System Supply Identifier | S652407 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 2 5MM NSTRL HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089630","type":"LOCAL"},{"code":"S652406","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089630 = Hospital System Supply Identifier | S652406 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 2 FULL WEDGE 7MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089712","type":"LOCAL"},{"code":"S652405","type":"LOCAL"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":134.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089712 = Hospital System Supply Identifier | S652405 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 2 THIRD WEDGE 8.7MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089632","type":"LOCAL"},{"code":"S652404","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":140.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089632 = Hospital System Supply Identifier | S652404 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 2 HALF WEDGE 14MM NSTRL CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089647","type":"LOCAL"},{"code":"S652403","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089647 = Hospital System Supply Identifier | S652403 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 2 20MM NSTRL REVISION ROTATE HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089629","type":"LOCAL"},{"code":"S652401","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089629 = Hospital System Supply Identifier | S652401 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 2 HALF WEDGE 8.6MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089610","type":"LOCAL"},{"code":"S652402","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089610 = Hospital System Supply Identifier | S652402 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 2 10MM NSTRL REVISION ROTATE HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089625","type":"LOCAL"},{"code":"S652399","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089625 = Hospital System Supply Identifier | S652399 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 2 10MM NSTRL FULL BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089623","type":"LOCAL"},{"code":"S652393","type":"LOCAL"}],"standard_charges":[{"gross_charge":822.5,"discounted_cash":287.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089623 = Hospital System Supply Identifier | S652393 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 2 HALF WEDGE 8.6MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089611","type":"LOCAL"},{"code":"S652394","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089611 = Hospital System Supply Identifier | S652394 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 2 HALF WEDGE 14MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089646","type":"LOCAL"},{"code":"S652395","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089646 = Hospital System Supply Identifier | S652395 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 2 15MM NSTRL REVISION ROTATE HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089627","type":"LOCAL"},{"code":"S652400","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089627 = Hospital System Supply Identifier | S652400 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 2 FULL WEDGE 7MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089713","type":"LOCAL"},{"code":"S652397","type":"LOCAL"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":134.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089713 = Hospital System Supply Identifier | S652397 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 2 5MM NSTRL REVISION ROTATE HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089631","type":"LOCAL"},{"code":"S652398","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089631 = Hospital System Supply Identifier | S652398 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 2 THIRD WEDGE 8.7MM NSTRL CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089633","type":"LOCAL"},{"code":"S652396","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":140.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089633 = Hospital System Supply Identifier | S652396 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 30MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089668","type":"LOCAL"},{"code":"S652428","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089668 = Hospital System Supply Identifier | S652428 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 3 HALF WEDGE 15MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089648","type":"LOCAL"},{"code":"S652420","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089648 = Hospital System Supply Identifier | S652420 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 20MM NSTRL REVISION ROTATE HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089666","type":"LOCAL"},{"code":"S652426","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089666 = Hospital System Supply Identifier | S652426 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 15MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089664","type":"LOCAL"},{"code":"S652425","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089664 = Hospital System Supply Identifier | S652425 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089661","type":"LOCAL"},{"code":"S652424","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089661 = Hospital System Supply Identifier | S652424 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 5MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089670","type":"LOCAL"},{"code":"S652423","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089670 = Hospital System Supply Identifier | S652423 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 3 FULL WEDGE 8MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089714","type":"LOCAL"},{"code":"S652422","type":"LOCAL"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":134.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089714 = Hospital System Supply Identifier | S652422 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 2 THIRD WEDGE 9.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089634","type":"LOCAL"},{"code":"S652421","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":140.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089634 = Hospital System Supply Identifier | S652421 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 30MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089669","type":"LOCAL"},{"code":"S652427","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089669 = Hospital System Supply Identifier | S652427 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 3 HALF WEDGE 9.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089612","type":"LOCAL"},{"code":"S652419","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089612 = Hospital System Supply Identifier | S652419 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 15MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089665","type":"LOCAL"},{"code":"S652417","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089665 = Hospital System Supply Identifier | S652417 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089662","type":"LOCAL"},{"code":"S652416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089662 = Hospital System Supply Identifier | S652416 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 5MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089671","type":"LOCAL"},{"code":"S652415","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089671 = Hospital System Supply Identifier | S652415 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 3 FULL WEDGE 8MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089715","type":"LOCAL"},{"code":"S652414","type":"LOCAL"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":134.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089715 = Hospital System Supply Identifier | S652414 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 2 THIRD WEDGE 9.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089635","type":"LOCAL"},{"code":"S652413","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":140.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089635 = Hospital System Supply Identifier | S652413 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 3 HALF WEDGE 15MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089649","type":"LOCAL"},{"code":"S652412","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089649 = Hospital System Supply Identifier | S652412 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 3 WEDGE 9.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089613","type":"LOCAL"},{"code":"S652411","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089613 = Hospital System Supply Identifier | S652411 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 10MM NSTRL FULL BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089660","type":"LOCAL"},{"code":"S652410","type":"LOCAL"}],"standard_charges":[{"gross_charge":822.5,"discounted_cash":287.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089660 = Hospital System Supply Identifier | S652410 = Lawson ID"}]},{"description":"PLATE BONE 3 WEDGE NSTRL PLATE STEM CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1100242","type":"LOCAL"},{"code":"S651493","type":"LOCAL"}],"standard_charges":[{"gross_charge":3175.2,"discounted_cash":1111.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1100242 = Hospital System Supply Identifier | S651493 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 20MM NSTRL REVISION ROTATE HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089667","type":"LOCAL"},{"code":"S652418","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089667 = Hospital System Supply Identifier | S652418 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 4 THIRD WEDGE 9.5MM NSTRL REVISION ROTATING HINGE BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089637","type":"LOCAL"},{"code":"S652440","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":140.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089637 = Hospital System Supply Identifier | S652440 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 30MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089679","type":"LOCAL"},{"code":"S652447","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089679 = Hospital System Supply Identifier | S652447 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 4 FULL WEDGE 8MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089716","type":"LOCAL"},{"code":"S652441","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":140.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089716 = Hospital System Supply Identifier | S652441 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 5MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089681","type":"LOCAL"},{"code":"S652442","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089681 = Hospital System Supply Identifier | S652442 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 4 HALF WEDGE 15MM NSTRL REVISION ROTATING HINGE BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089651","type":"LOCAL"},{"code":"S652439","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089651 = Hospital System Supply Identifier | S652439 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 15MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089675","type":"LOCAL"},{"code":"S652444","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089675 = Hospital System Supply Identifier | S652444 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 20MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089677","type":"LOCAL"},{"code":"S652445","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089677 = Hospital System Supply Identifier | S652445 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 30MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089680","type":"LOCAL"},{"code":"S652446","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089680 = Hospital System Supply Identifier | S652446 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089673","type":"LOCAL"},{"code":"S652443","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089673 = Hospital System Supply Identifier | S652443 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 4 HALF WEDGE 9.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089614","type":"LOCAL"},{"code":"S652438","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089614 = Hospital System Supply Identifier | S652438 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 5MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089682","type":"LOCAL"},{"code":"S652434","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089682 = Hospital System Supply Identifier | S652434 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 15MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089676","type":"LOCAL"},{"code":"S652436","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089676 = Hospital System Supply Identifier | S652436 = Lawson ID"}]},{"description":"PLATE BONE 4 WEDGE NSTRL PLATE STEM CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1100258","type":"LOCAL"},{"code":"S651494","type":"LOCAL"}],"standard_charges":[{"gross_charge":3175.2,"discounted_cash":1111.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1100258 = Hospital System Supply Identifier | S651494 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 10MM NSTRL FULL BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089672","type":"LOCAL"},{"code":"S652429","type":"LOCAL"}],"standard_charges":[{"gross_charge":822.5,"discounted_cash":287.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089672 = Hospital System Supply Identifier | S652429 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 4 HALF WEDGE 9.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089615","type":"LOCAL"},{"code":"S652430","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089615 = Hospital System Supply Identifier | S652430 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 20MM NSTRL REVISION ROTATE HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089678","type":"LOCAL"},{"code":"S652437","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089678 = Hospital System Supply Identifier | S652437 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 4 THIRD WEDGE 9.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089636","type":"LOCAL"},{"code":"S652432","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":140.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089636 = Hospital System Supply Identifier | S652432 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 4 FULL WEDGE 8MM NSTRL CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089717","type":"LOCAL"},{"code":"S652433","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":140.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089717 = Hospital System Supply Identifier | S652433 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089674","type":"LOCAL"},{"code":"S652435","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089674 = Hospital System Supply Identifier | S652435 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 4 HALF WEDGE 15MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089650","type":"LOCAL"},{"code":"S652431","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089650 = Hospital System Supply Identifier | S652431 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 5 THIRD WEDGE 5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089639","type":"LOCAL"},{"code":"S652458","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":140.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089639 = Hospital System Supply Identifier | S652458 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 5 30MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089689","type":"LOCAL"},{"code":"S652465","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089689 = Hospital System Supply Identifier | S652465 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 5 30MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089690","type":"LOCAL"},{"code":"S652464","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089690 = Hospital System Supply Identifier | S652464 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 5 20MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089687","type":"LOCAL"},{"code":"S652463","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089687 = Hospital System Supply Identifier | S652463 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 5 15MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089685","type":"LOCAL"},{"code":"S652462","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089685 = Hospital System Supply Identifier | S652462 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 5 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089683","type":"LOCAL"},{"code":"S652461","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089683 = Hospital System Supply Identifier | S652461 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 5 5MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089691","type":"LOCAL"},{"code":"S652460","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089691 = Hospital System Supply Identifier | S652460 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 5 FULL WEDGE 9MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089718","type":"LOCAL"},{"code":"S652459","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":140.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089718 = Hospital System Supply Identifier | S652459 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 5 HALF WEDGE 17MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089652","type":"LOCAL"},{"code":"S652457","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089652 = Hospital System Supply Identifier | S652457 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 5 HALF WEDGE 10.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089616","type":"LOCAL"},{"code":"S652456","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089616 = Hospital System Supply Identifier | S652456 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 5 20MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089688","type":"LOCAL"},{"code":"S652455","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089688 = Hospital System Supply Identifier | S652455 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 5 HALF WEDGE 10.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089617","type":"LOCAL"},{"code":"S652448","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089617 = Hospital System Supply Identifier | S652448 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 5 HALF WEDGE 17MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089653","type":"LOCAL"},{"code":"S652449","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089653 = Hospital System Supply Identifier | S652449 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 5 THIRD WEDGE 10MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089638","type":"LOCAL"},{"code":"S652450","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":140.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089638 = Hospital System Supply Identifier | S652450 = Lawson ID"}]},{"description":"PLATE BONE 5 WEDGE NSTRL PLATE STEM CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1100267","type":"LOCAL"},{"code":"S651495","type":"LOCAL"}],"standard_charges":[{"gross_charge":3175.2,"discounted_cash":1111.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1100267 = Hospital System Supply Identifier | S651495 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 5 5MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089692","type":"LOCAL"},{"code":"S652452","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089692 = Hospital System Supply Identifier | S652452 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 5 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089684","type":"LOCAL"},{"code":"S652453","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089684 = Hospital System Supply Identifier | S652453 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 5 15MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089686","type":"LOCAL"},{"code":"S652454","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089686 = Hospital System Supply Identifier | S652454 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 5 FULL WEDGE 9MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089719","type":"LOCAL"},{"code":"S652451","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":140.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089719 = Hospital System Supply Identifier | S652451 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 6 HALF WEDGE 17MM NSTRL CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089655","type":"LOCAL"},{"code":"S652476","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089655 = Hospital System Supply Identifier | S652476 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 6 30MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089700","type":"LOCAL"},{"code":"S652483","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089700 = Hospital System Supply Identifier | S652483 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 6 20MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089698","type":"LOCAL"},{"code":"S652482","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089698 = Hospital System Supply Identifier | S652482 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 6 15MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089696","type":"LOCAL"},{"code":"S652481","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089696 = Hospital System Supply Identifier | S652481 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 6 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089694","type":"LOCAL"},{"code":"S652480","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089694 = Hospital System Supply Identifier | S652480 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 6 5MM NSTRL HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089702","type":"LOCAL"},{"code":"S652479","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089702 = Hospital System Supply Identifier | S652479 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 6 FULL WEDGE 9MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089720","type":"LOCAL"},{"code":"S652478","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089720 = Hospital System Supply Identifier | S652478 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 6 THIRD WEDGE 10MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089640","type":"LOCAL"},{"code":"S652477","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":140.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089640 = Hospital System Supply Identifier | S652477 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 6 HALF WEDGE 10.5MM NSTRL CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089618","type":"LOCAL"},{"code":"S652475","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089618 = Hospital System Supply Identifier | S652475 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 6 15MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089697","type":"LOCAL"},{"code":"S652473","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089697 = Hospital System Supply Identifier | S652473 = Lawson ID"}]},{"description":"PLATE BONE 6 WEDGE NSTRL PLATE STEM CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1100275","type":"LOCAL"},{"code":"S651496","type":"LOCAL"}],"standard_charges":[{"gross_charge":3175.2,"discounted_cash":1111.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1100275 = Hospital System Supply Identifier | S651496 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 6 10MM NSTRL FULL BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089693","type":"LOCAL"},{"code":"S652466","type":"LOCAL"}],"standard_charges":[{"gross_charge":822.5,"discounted_cash":287.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089693 = Hospital System Supply Identifier | S652466 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 16 HALF WEDGE 10.5MM NSTRL CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089609","type":"LOCAL"},{"code":"S652467","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089609 = Hospital System Supply Identifier | S652467 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 6 HALF WEDGE 17MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089654","type":"LOCAL"},{"code":"S652468","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089654 = Hospital System Supply Identifier | S652468 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 6 20MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089699","type":"LOCAL"},{"code":"S652474","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089699 = Hospital System Supply Identifier | S652474 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 6 FULL WEDGE 9MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089721","type":"LOCAL"},{"code":"S652470","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089721 = Hospital System Supply Identifier | S652470 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 6 5MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089701","type":"LOCAL"},{"code":"S652471","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089701 = Hospital System Supply Identifier | S652471 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 6 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089695","type":"LOCAL"},{"code":"S652472","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089695 = Hospital System Supply Identifier | S652472 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 6 THIRD WEDGE 10MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089641","type":"LOCAL"},{"code":"S652469","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":140.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089641 = Hospital System Supply Identifier | S652469 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 7 HALF WEDGE 11.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089619","type":"LOCAL"},{"code":"S652493","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089619 = Hospital System Supply Identifier | S652493 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7 20MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089708","type":"LOCAL"},{"code":"S652500","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089708 = Hospital System Supply Identifier | S652500 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7 15MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089706","type":"LOCAL"},{"code":"S652499","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089706 = Hospital System Supply Identifier | S652499 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089704","type":"LOCAL"},{"code":"S652498","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089704 = Hospital System Supply Identifier | S652498 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7 5MM NSTRL HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089711","type":"LOCAL"},{"code":"S652497","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089711 = Hospital System Supply Identifier | S652497 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 7 FULL WEDGE 10MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089722","type":"LOCAL"},{"code":"S652496","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":140.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089722 = Hospital System Supply Identifier | S652496 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 7 THIRD WEDGE 10.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089642","type":"LOCAL"},{"code":"S652495","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":140.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089642 = Hospital System Supply Identifier | S652495 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 7 HALF WEDGE 18.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089656","type":"LOCAL"},{"code":"S652494","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089656 = Hospital System Supply Identifier | S652494 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7 15MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089707","type":"LOCAL"},{"code":"S652491","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089707 = Hospital System Supply Identifier | S652491 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 7 FULL WEDGE 10MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089723","type":"LOCAL"},{"code":"S652488","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":140.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089723 = Hospital System Supply Identifier | S652488 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089705","type":"LOCAL"},{"code":"S652490","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089705 = Hospital System Supply Identifier | S652490 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7 5MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089710","type":"LOCAL"},{"code":"S652489","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089710 = Hospital System Supply Identifier | S652489 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 7 THIRD WEDGE 10.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089643","type":"LOCAL"},{"code":"S652487","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":140.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089643 = Hospital System Supply Identifier | S652487 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 7 HALF WEDGE 18.5MM NSTRL CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089657","type":"LOCAL"},{"code":"S652486","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089657 = Hospital System Supply Identifier | S652486 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 7 HALF WEDGE 11.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089620","type":"LOCAL"},{"code":"S652485","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089620 = Hospital System Supply Identifier | S652485 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7 10MM NSTRL FULL BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089703","type":"LOCAL"},{"code":"S652484","type":"LOCAL"}],"standard_charges":[{"gross_charge":822.5,"discounted_cash":287.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089703 = Hospital System Supply Identifier | S652484 = Lawson ID"}]},{"description":"PLATE BONE 7 WEDGE NSTRL PLATE STEM CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1100281","type":"LOCAL"},{"code":"S651497","type":"LOCAL"}],"standard_charges":[{"gross_charge":3175.2,"discounted_cash":1111.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1100281 = Hospital System Supply Identifier | S651497 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7 20MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089709","type":"LOCAL"},{"code":"S652492","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089709 = Hospital System Supply Identifier | S652492 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 8-9 THIRD WEDGE 10.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089644","type":"LOCAL"},{"code":"S652512","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":140.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089644 = Hospital System Supply Identifier | S652512 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 8-9 HALF WEDGE 18.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089659","type":"LOCAL"},{"code":"S652511","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089659 = Hospital System Supply Identifier | S652511 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 8 FULL WEDGE 10MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089724","type":"LOCAL"},{"code":"S652513","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089724 = Hospital System Supply Identifier | S652513 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 8-9 HALF WEDGE 11.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089621","type":"LOCAL"},{"code":"S652510","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089621 = Hospital System Supply Identifier | S652510 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 8 20MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089732","type":"LOCAL"},{"code":"S652517","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089732 = Hospital System Supply Identifier | S652517 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 8 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089729","type":"LOCAL"},{"code":"S652515","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089729 = Hospital System Supply Identifier | S652515 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 8 15MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089730","type":"LOCAL"},{"code":"S652516","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089730 = Hospital System Supply Identifier | S652516 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 8-9 5MM NSTRL HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089735","type":"LOCAL"},{"code":"S652514","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089735 = Hospital System Supply Identifier | S652514 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 8 20MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089733","type":"LOCAL"},{"code":"S652509","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089733 = Hospital System Supply Identifier | S652509 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 8-9 HALF WEDGE 11.5MM NSTRL CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089622","type":"LOCAL"},{"code":"S652502","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089622 = Hospital System Supply Identifier | S652502 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 8-9 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089734","type":"LOCAL"},{"code":"S652507","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.32,"discounted_cash":491.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089734 = Hospital System Supply Identifier | S652507 = Lawson ID"}]},{"description":"PLATE BONE 8 WEDGE NSTRL PLATE STEM CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1100287","type":"LOCAL"},{"code":"S651498","type":"LOCAL"}],"standard_charges":[{"gross_charge":3175.2,"discounted_cash":1111.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1100287 = Hospital System Supply Identifier | S651498 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 8 10MM NSTRL FULL BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089728","type":"LOCAL"},{"code":"S652501","type":"LOCAL"}],"standard_charges":[{"gross_charge":822.5,"discounted_cash":287.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089728 = Hospital System Supply Identifier | S652501 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 8 9 HALF WEDGE 18.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089658","type":"LOCAL"},{"code":"S652503","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: JVCPCT LOCATION | 1089658 = Hospital System Supply Identifier | S652503 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 8 15MM NSTRL REVISION ROTATING HINGE HALF