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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":"Jennifer Bryan"},"financial_aid_policy":["58% 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. 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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":1930.0,"discounted_cash":810.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS 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":1930.0,"discounted_cash":810.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 168547 = Hospital System Supply Identifier | 208819 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 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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":1930.0,"discounted_cash":810.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 303195 = Hospital System Supply Identifier | 522141 = 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":1930.0,"discounted_cash":810.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 303196 = Hospital System Supply Identifier | 522142 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 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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":1930.0,"discounted_cash":810.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 303200 = Hospital System Supply Identifier | 522146 = 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":1930.0,"discounted_cash":810.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 303199 = Hospital System Supply Identifier | 522145 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 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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":1930.0,"discounted_cash":810.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 303201 = Hospital System Supply Identifier | 522147 = 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":1930.0,"discounted_cash":810.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 303202 = Hospital System Supply Identifier | 522148 = 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":1930.0,"discounted_cash":810.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS 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":1930.0,"discounted_cash":810.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS 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":1930.0,"discounted_cash":810.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS 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":1930.0,"discounted_cash":810.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 303205 = Hospital System Supply Identifier | 522151 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 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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":6864.0,"discounted_cash":2882.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 329040 = Hospital System Supply Identifier | 223413 = 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":6864.0,"discounted_cash":2882.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 329039 = Hospital System Supply Identifier | 223412 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 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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":6864.0,"discounted_cash":2882.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS 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":6864.0,"discounted_cash":2882.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 192130 = Hospital System Supply Identifier | 223405 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 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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":6864.0,"discounted_cash":2882.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 146880 = Hospital System Supply Identifier | 223407 = 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":6864.0,"discounted_cash":2882.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 329150 = Hospital System Supply Identifier | 258420 = Lawson ID"}]},{"description":"IMP TIB STEM EXT STR 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15","code_information":[{"code":"Sx00-5990-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322822","type":"LOCAL"},{"code":"536037","type":"LOCAL"}],"standard_charges":[{"gross_charge":6471.43,"discounted_cash":2718.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 322822 = Hospital System Supply Identifier | 536037 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST SZF 20","code_information":[{"code":"Sx00-5990-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322823","type":"LOCAL"},{"code":"536038","type":"LOCAL"}],"standard_charges":[{"gross_charge":6639.36,"discounted_cash":2788.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 322823 = Hospital System Supply Identifier | 536038 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST SZG 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53.5X60MM","code_information":[{"code":"Sx00-5994-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326349","type":"LOCAL"},{"code":"395769","type":"LOCAL"}],"standard_charges":[{"gross_charge":18798.0,"discounted_cash":7895.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 326349 = Hospital System Supply Identifier | 395769 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LCCK LT SZD","code_information":[{"code":"Sx00-5994-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194027","type":"LOCAL"},{"code":"324221","type":"LOCAL"}],"standard_charges":[{"gross_charge":18798.0,"discounted_cash":7895.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 194027 = Hospital System Supply Identifier | 324221 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LCCK RT 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CD1-2/17","code_information":[{"code":"Sx00-5994-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202244","type":"LOCAL"},{"code":"452342","type":"LOCAL"}],"standard_charges":[{"gross_charge":9098.5,"discounted_cash":3821.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 202244 = Hospital System Supply Identifier | 452342 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 1-2 10","code_information":[{"code":"Sx00-5994-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322047","type":"LOCAL"},{"code":"535261","type":"LOCAL"}],"standard_charges":[{"gross_charge":9098.5,"discounted_cash":3821.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 322047 = Hospital System Supply Identifier | 535261 = Lawson ID"}]},{"description":"IMP TIB NXGN SZ1-2 23MM","code_information":[{"code":"Sx00-5994-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198028","type":"LOCAL"},{"code":"443264","type":"LOCAL"}],"standard_charges":[{"gross_charge":9098.5,"discounted_cash":3821.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 198028 = Hospital System Supply Identifier | 443264 = Lawson ID"}]},{"description":"IMP KNEE INS NXGN LOK CD1-2/12","code_information":[{"code":"Sx00-5994-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202243","type":"LOCAL"},{"code":"452341","type":"LOCAL"}],"standard_charges":[{"gross_charge":9098.5,"discounted_cash":3821.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 202243 = Hospital System Supply Identifier | 452341 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN MIC","code_information":[{"code":"Sx00-5994-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327175","type":"LOCAL"},{"code":"412372","type":"LOCAL"}],"standard_charges":[{"gross_charge":9098.5,"discounted_cash":3821.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 327175 = Hospital System Supply Identifier | 412372 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 3-4 10MM","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329394","type":"LOCAL"},{"code":"324226","type":"LOCAL"}],"standard_charges":[{"gross_charge":9098.5,"discounted_cash":3821.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 329394 = Hospital System Supply Identifier | 324226 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 3-4 17MM","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194029","type":"LOCAL"},{"code":"324227","type":"LOCAL"}],"standard_charges":[{"gross_charge":9098.5,"discounted_cash":3821.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 194029 = Hospital System Supply Identifier | 324227 = Lawson ID"}]},{"description":"IMP TIB INS POST NXGN SZ3-4 20","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329395","type":"LOCAL"},{"code":"324228","type":"LOCAL"}],"standard_charges":[{"gross_charge":9098.5,"discounted_cash":3821.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 329395 = Hospital System Supply Identifier | 324228 = Lawson ID"}]},{"description":"IMP LCCK ART SURF CD 3-4 YE","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"317062","type":"LOCAL"},{"code":"446541","type":"LOCAL"}],"standard_charges":[{"gross_charge":9098.5,"discounted_cash":3821.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 317062 = Hospital System Supply Identifier | 446541 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 3-4 12","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322050","type":"LOCAL"},{"code":"535264","type":"LOCAL"}],"standard_charges":[{"gross_charge":9098.5,"discounted_cash":3821.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 322050 = Hospital System Supply Identifier | 535264 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 3-4 23","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322051","type":"LOCAL"},{"code":"535265","type":"LOCAL"}],"standard_charges":[{"gross_charge":9098.5,"discounted_cash":3821.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 322051 = Hospital System Supply Identifier | 535265 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 3-4 10MM","code_information":[{"code":"Sx00-5994-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178421","type":"LOCAL"},{"code":"337485","type":"LOCAL"}],"standard_charges":[{"gross_charge":9098.5,"discounted_cash":3821.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 178421 = Hospital System Supply Identifier | 337485 = Lawson ID"}]},{"description":"IMP TIB INS NXGN SZ3-4 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6310-42-22","code_information":[{"code":"Sx00-6310-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328932","type":"LOCAL"},{"code":"204640","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 328932 = Hospital System Supply Identifier | 204640 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 42X26","code_information":[{"code":"Sx00-6310-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304261","type":"LOCAL"},{"code":"523218","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304261 = Hospital System Supply Identifier | 523218 = Lawson ID"}]},{"description":"LINER 10 TRILOGY 6310-44-22","code_information":[{"code":"Sx00-6310-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328931","type":"LOCAL"},{"code":"204639","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 328931 = Hospital System Supply Identifier | 204639 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 26X44MM","code_information":[{"code":"Sx00-6310-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326725","type":"LOCAL"},{"code":"408165","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 326725 = Hospital System Supply Identifier | 408165 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 28X44MM","code_information":[{"code":"Sx00-6310-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196298","type":"LOCAL"},{"code":"408166","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 196298 = Hospital System Supply Identifier | 408166 = Lawson ID"}]},{"description":"LINER 10 TRILOGY 6310-46-22","code_information":[{"code":"Sx00-6310-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328999","type":"LOCAL"},{"code":"208601","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 328999 = Hospital System Supply Identifier | 208601 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 26X46MM","code_information":[{"code":"Sx00-6310-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326726","type":"LOCAL"},{"code":"408167","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 326726 = Hospital System Supply Identifier | 408167 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 28X46MM","code_information":[{"code":"Sx00-6310-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196299","type":"LOCAL"},{"code":"408168","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 196299 = Hospital System Supply Identifier | 408168 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 48X22","code_information":[{"code":"Sx00-6310-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304262","type":"LOCAL"},{"code":"523219","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304262 = Hospital System Supply Identifier | 523219 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 32X48MM","code_information":[{"code":"Sx00-6310-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196300","type":"LOCAL"},{"code":"408170","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 196300 = Hospital System Supply Identifier | 408170 = Lawson ID"}]},{"description":"LINER 10 TRILOGY 6310-48-28","code_information":[{"code":"Sx00-6310-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167751","type":"LOCAL"},{"code":"203488","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 167751 = Hospital System Supply Identifier | 203488 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 26X48MM","code_information":[{"code":"Sx00-6310-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326727","type":"LOCAL"},{"code":"408169","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 326727 = Hospital System Supply Identifier | 408169 = Lawson ID"}]},{"description":"LINER 10 TRILOGY 6310-50-28","code_information":[{"code":"Sx00-6310-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167756","type":"LOCAL"},{"code":"203496","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 167756 = Hospital System Supply Identifier | 203496 = Lawson ID"}]},{"description":"LINER ACETAB 32M 10 LONGEVITY","code_information":[{"code":"Sx00-6310-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168180","type":"LOCAL"},{"code":"206426","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 168180 = Hospital System Supply Identifier | 206426 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 26X50MM","code_information":[{"code":"Sx00-6310-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326728","type":"LOCAL"},{"code":"408171","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 326728 = Hospital System Supply Identifier | 408171 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 50-54X22","code_information":[{"code":"Sx00-6310-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304263","type":"LOCAL"},{"code":"523220","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304263 = Hospital System Supply Identifier | 523220 = Lawson ID"}]},{"description":"LINER 10 TRILOGY 6310-56-28","code_information":[{"code":"Sx00-6310-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167755","type":"LOCAL"},{"code":"203495","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 167755 = Hospital System Supply Identifier | 203495 = Lawson ID"}]},{"description":"LINER ACETAB 32M 10 LONGEVITY","code_information":[{"code":"Sx00-6310-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328960","type":"LOCAL"},{"code":"206427","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 328960 = Hospital System Supply Identifier | 206427 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 26X56MM","code_information":[{"code":"Sx00-6310-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326729","type":"LOCAL"},{"code":"408172","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 326729 = Hospital System Supply Identifier | 408172 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 56X22","code_information":[{"code":"Sx00-6310-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304264","type":"LOCAL"},{"code":"523221","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304264 = Hospital System Supply Identifier | 523221 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 26X58MM","code_information":[{"code":"Sx00-6310-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326730","type":"LOCAL"},{"code":"408173","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 326730 = Hospital System Supply Identifier | 408173 = Lawson ID"}]},{"description":"IMP HIP ACET LNR LGVTY 36MM","code_information":[{"code":"Sx00-6310-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"149141","type":"LOCAL"},{"code":"236444","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 149141 = Hospital System Supply Identifier | 236444 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 58X22","code_information":[{"code":"Sx00-6310-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304265","type":"LOCAL"},{"code":"523222","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304265 = Hospital System Supply Identifier | 523222 = Lawson ID"}]},{"description":"LINER 10 TRILOGY 6310-58-28","code_information":[{"code":"Sx00-6310-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167838","type":"LOCAL"},{"code":"203909","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 167838 = Hospital System Supply Identifier | 203909 = Lawson ID"}]},{"description":"LINER ACETAB 32M 10 LONGEVITY","code_information":[{"code":"Sx00-6310-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328961","type":"LOCAL"},{"code":"206428","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 328961 = Hospital System Supply Identifier | 206428 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 60X26","code_information":[{"code":"Sx00-6310-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304267","type":"LOCAL"},{"code":"523224","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304267 = Hospital System Supply Identifier | 523224 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 60X22","code_information":[{"code":"Sx00-6310-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304266","type":"LOCAL"},{"code":"523223","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304266 = Hospital System Supply Identifier | 523223 = Lawson ID"}]},{"description":"LINER 10 TRILOGY 6310-60-28","code_information":[{"code":"Sx00-6310-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167754","type":"LOCAL"},{"code":"203494","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 167754 = Hospital System Supply Identifier | 203494 = Lawson ID"}]},{"description":"LINER ACETAB 32M 10 LONGEVITY","code_information":[{"code":"Sx00-6310-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328962","type":"LOCAL"},{"code":"206429","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 328962 = Hospital System Supply Identifier | 206429 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 60X36","code_information":[{"code":"Sx00-6310-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"159043","type":"LOCAL"},{"code":"325078","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 159043 = Hospital System Supply Identifier | 325078 = Lawson ID"}]},{"description":"LINER 10 TRILOGY 6310-62-28","code_information":[{"code":"Sx00-6310-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167753","type":"LOCAL"},{"code":"203493","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 167753 = Hospital System Supply Identifier | 203493 = Lawson ID"}]},{"description":"LINER ACETAB 32M 10 LONGEVITY","code_information":[{"code":"Sx00-6310-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168181","type":"LOCAL"},{"code":"206430","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 168181 = Hospital System Supply Identifier | 206430 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 62X22","code_information":[{"code":"Sx00-6310-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304268","type":"LOCAL"},{"code":"523225","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304268 = Hospital System Supply Identifier | 523225 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 62X26","code_information":[{"code":"Sx00-6310-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304269","type":"LOCAL"},{"code":"523226","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304269 = Hospital System Supply Identifier | 523226 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 62X36","code_information":[{"code":"Sx00-6310-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304270","type":"LOCAL"},{"code":"523227","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304270 = Hospital System Supply Identifier | 523227 = Lawson ID"}]},{"description":"LINER 10 TRILOGY 6310-64-28","code_information":[{"code":"Sx00-6310-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167752","type":"LOCAL"},{"code":"203489","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 167752 = Hospital System Supply Identifier | 203489 = Lawson ID"}]},{"description":"LINER ACETAB 32M 10 LONGEVITY","code_information":[{"code":"Sx00-6310-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328963","type":"LOCAL"},{"code":"206431","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 328963 = Hospital System Supply Identifier | 206431 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 64X36","code_information":[{"code":"Sx00-6310-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324846","type":"LOCAL"},{"code":"324310","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 324846 = Hospital System Supply Identifier | 324310 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 64X22","code_information":[{"code":"Sx00-6310-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304271","type":"LOCAL"},{"code":"523228","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304271 = Hospital System Supply Identifier | 523228 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 64X26","code_information":[{"code":"Sx00-6310-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304272","type":"LOCAL"},{"code":"523229","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304272 = Hospital System Supply Identifier | 523229 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 66X26","code_information":[{"code":"Sx00-6310-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304274","type":"LOCAL"},{"code":"523231","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304274 = Hospital System Supply Identifier | 523231 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 66X22","code_information":[{"code":"Sx00-6310-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304273","type":"LOCAL"},{"code":"523230","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304273 = Hospital System Supply Identifier | 523230 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 66X36","code_information":[{"code":"Sx00-6310-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324847","type":"LOCAL"},{"code":"324311","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 324847 = Hospital System Supply Identifier | 324311 = Lawson ID"}]},{"description":"LINER 10 TRILOGY 6310-66-28","code_information":[{"code":"Sx00-6310-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328924","type":"LOCAL"},{"code":"203490","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 328924 = Hospital System Supply Identifier | 203490 = Lawson ID"}]},{"description":"LINER ACETAB 32M 10 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6310-70-28","code_information":[{"code":"Sx00-6310-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328926","type":"LOCAL"},{"code":"203492","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 328926 = Hospital System Supply Identifier | 203492 = Lawson ID"}]},{"description":"LINER ACETAB 32M 10 LONGEVITY","code_information":[{"code":"Sx00-6310-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328966","type":"LOCAL"},{"code":"206434","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 328966 = Hospital System Supply Identifier | 206434 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 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36X22","code_information":[{"code":"Sx00-6320-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304303","type":"LOCAL"},{"code":"523260","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304303 = Hospital System Supply Identifier | 523260 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 38X22","code_information":[{"code":"Sx00-6320-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304304","type":"LOCAL"},{"code":"523261","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304304 = Hospital System Supply Identifier | 523261 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 40X22","code_information":[{"code":"Sx00-6320-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304305","type":"LOCAL"},{"code":"523262","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304305 = Hospital System Supply Identifier | 523262 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 42X22","code_information":[{"code":"Sx00-6320-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304306","type":"LOCAL"},{"code":"523263","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304306 = Hospital System Supply Identifier | 523263 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 42X26","code_information":[{"code":"Sx00-6320-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304307","type":"LOCAL"},{"code":"523264","type":"LOCAL"}],"standard_charges":[{"gross_charge":6508.32,"discounted_cash":2733.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304307 = Hospital System Supply Identifier | 523264 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 44X28","code_information":[{"code":"Sx00-6320-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304310","type":"LOCAL"},{"code":"523267","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304310 = Hospital System Supply Identifier | 523267 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 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46X26","code_information":[{"code":"Sx00-6320-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304312","type":"LOCAL"},{"code":"523269","type":"LOCAL"}],"standard_charges":[{"gross_charge":6508.32,"discounted_cash":2733.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304312 = Hospital System Supply Identifier | 523269 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 46X28","code_information":[{"code":"Sx00-6320-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304313","type":"LOCAL"},{"code":"523270","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304313 = Hospital System Supply Identifier | 523270 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 46X22","code_information":[{"code":"Sx00-6320-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304311","type":"LOCAL"},{"code":"523268","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304311 = Hospital System Supply Identifier | 523268 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 48X28","code_information":[{"code":"Sx00-6320-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304316","type":"LOCAL"},{"code":"523273","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304316 = Hospital System Supply Identifier | 523273 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 48X32","code_information":[{"code":"Sx00-6320-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304317","type":"LOCAL"},{"code":"523274","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304317 = Hospital System Supply Identifier | 523274 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 48X22","code_information":[{"code":"Sx00-6320-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304314","type":"LOCAL"},{"code":"523271","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 304314 = Hospital System Supply Identifier | 523271 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 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68X28","code_information":[{"code":"Sx00-6341-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326737","type":"LOCAL"},{"code":"408180","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 326737 = Hospital System Supply Identifier | 408180 = Lawson ID"}]},{"description":"LINER LONGEVITY 7MM OFFSET 32M","code_information":[{"code":"Sx00-6341-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328989","type":"LOCAL"},{"code":"206471","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 328989 = Hospital System Supply Identifier | 206471 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 7MM OFF 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58MM","code_information":[{"code":"Sx00-7053-058","type":"CDM"},{"code":"272","type":"RC"},{"code":"168606","type":"LOCAL"},{"code":"210140","type":"LOCAL"}],"standard_charges":[{"gross_charge":3824.8,"discounted_cash":1606.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 168606 = Hospital System Supply Identifier | 210140 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 58MM","code_information":[{"code":"Sx00-7053-058","type":"CDM"},{"code":"272","type":"RC"},{"code":"192038","type":"LOCAL"},{"code":"210144","type":"LOCAL"}],"standard_charges":[{"gross_charge":3824.8,"discounted_cash":1606.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 192038 = Hospital System Supply Identifier | 210144 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 60MM","code_information":[{"code":"Sx00-7053-060","type":"CDM"},{"code":"272","type":"RC"},{"code":"192037","type":"LOCAL"},{"code":"210141","type":"LOCAL"}],"standard_charges":[{"gross_charge":3824.8,"discounted_cash":1606.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 192037 = Hospital System Supply Identifier | 210141 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 60MM","code_information":[{"code":"Sx00-7053-060","type":"CDM"},{"code":"272","type":"RC"},{"code":"192039","type":"LOCAL"},{"code":"210145","type":"LOCAL"}],"standard_charges":[{"gross_charge":3824.8,"discounted_cash":1606.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 192039 = Hospital System Supply Identifier | 210145 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 62MM","code_information":[{"code":"Sx00-7053-062","type":"CDM"},{"code":"272","type":"RC"},{"code":"95111","type":"LOCAL"},{"code":"310991","type":"LOCAL"}],"standard_charges":[{"gross_charge":3824.8,"discounted_cash":1606.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 95111 = Hospital System Supply Identifier | 310991 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 62MM","code_information":[{"code":"Sx00-7053-062","type":"CDM"},{"code":"272","type":"RC"},{"code":"95112","type":"LOCAL"},{"code":"310998","type":"LOCAL"}],"standard_charges":[{"gross_charge":3824.8,"discounted_cash":1606.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 95112 = Hospital System Supply Identifier | 310998 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 64MM","code_information":[{"code":"Sx00-7053-064","type":"CDM"},{"code":"272","type":"RC"},{"code":"192040","type":"LOCAL"},{"code":"210146","type":"LOCAL"}],"standard_charges":[{"gross_charge":3824.8,"discounted_cash":1606.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 192040 = Hospital System Supply Identifier | 210146 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 64MM","code_information":[{"code":"Sx00-7053-064","type":"CDM"},{"code":"272","type":"RC"},{"code":"192041","type":"LOCAL"},{"code":"210147","type":"LOCAL"}],"standard_charges":[{"gross_charge":3824.8,"discounted_cash":1606.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 192041 = Hospital System Supply Identifier | 210147 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 66MM","code_information":[{"code":"Sx00-7053-066","type":"CDM"},{"code":"272","type":"RC"},{"code":"193497","type":"LOCAL"},{"code":"310999","type":"LOCAL"}],"standard_charges":[{"gross_charge":3824.8,"discounted_cash":1606.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 193497 = Hospital System Supply Identifier | 310999 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 66MM","code_information":[{"code":"Sx00-7053-066","type":"CDM"},{"code":"272","type":"RC"},{"code":"193493","type":"LOCAL"},{"code":"310992","type":"LOCAL"}],"standard_charges":[{"gross_charge":3824.8,"discounted_cash":1606.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 193493 = Hospital System Supply Identifier | 310992 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 68MM","code_information":[{"code":"Sx00-7053-068","type":"CDM"},{"code":"272","type":"RC"},{"code":"193494","type":"LOCAL"},{"code":"310993","type":"LOCAL"}],"standard_charges":[{"gross_charge":3824.8,"discounted_cash":1606.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 193494 = Hospital System Supply Identifier | 310993 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 68MM","code_information":[{"code":"Sx00-7053-068","type":"CDM"},{"code":"272","type":"RC"},{"code":"193498","type":"LOCAL"},{"code":"311000","type":"LOCAL"}],"standard_charges":[{"gross_charge":3824.8,"discounted_cash":1606.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 193498 = Hospital System Supply Identifier | 311000 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 70MM","code_information":[{"code":"Sx00-7053-070","type":"CDM"},{"code":"272","type":"RC"},{"code":"195056","type":"LOCAL"},{"code":"361331","type":"LOCAL"}],"standard_charges":[{"gross_charge":3824.8,"discounted_cash":1606.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 195056 = Hospital System Supply Identifier | 361331 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 70MM","code_information":[{"code":"Sx00-7053-070","type":"CDM"},{"code":"272","type":"RC"},{"code":"195058","type":"LOCAL"},{"code":"361333","type":"LOCAL"}],"standard_charges":[{"gross_charge":3824.8,"discounted_cash":1606.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 195058 = Hospital System Supply Identifier | 361333 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 72MM","code_information":[{"code":"Sx00-7053-072","type":"CDM"},{"code":"272","type":"RC"},{"code":"195057","type":"LOCAL"},{"code":"361332","type":"LOCAL"}],"standard_charges":[{"gross_charge":3824.8,"discounted_cash":1606.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 195057 = Hospital System Supply Identifier | 361332 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 72MM","code_information":[{"code":"Sx00-7053-072","type":"CDM"},{"code":"272","type":"RC"},{"code":"195059","type":"LOCAL"},{"code":"361334","type":"LOCAL"}],"standard_charges":[{"gross_charge":3824.8,"discounted_cash":1606.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 195059 = Hospital System Supply Identifier | 361334 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 28X48MM","code_information":[{"code":"Sx00-7105-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198404","type":"LOCAL"},{"code":"443656","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 198404 = Hospital System Supply Identifier | 443656 = Lawson ID"}]},{"description":"IMP HIP ACET LNR NEUT 0D 28X50","code_information":[{"code":"Sx00-7105-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320927","type":"LOCAL"},{"code":"534141","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320927 = Hospital System Supply Identifier | 534141 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 0D 28X52MM","code_information":[{"code":"Sx00-7105-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198403","type":"LOCAL"},{"code":"443655","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 198403 = Hospital System Supply Identifier | 443655 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 0D 32X54MM","code_information":[{"code":"Sx00-7105-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202086","type":"LOCAL"},{"code":"452182","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 202086 = Hospital System Supply Identifier | 452182 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 54X28","code_information":[{"code":"Sx00-7105-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320928","type":"LOCAL"},{"code":"534142","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320928 = Hospital System Supply Identifier | 534142 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 56X28","code_information":[{"code":"Sx00-7105-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320929","type":"LOCAL"},{"code":"534143","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320929 = Hospital System Supply Identifier | 534143 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 56X32","code_information":[{"code":"Sx00-7105-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320930","type":"LOCAL"},{"code":"534144","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320930 = Hospital System Supply Identifier | 534144 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 58X28","code_information":[{"code":"Sx00-7105-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320931","type":"LOCAL"},{"code":"534145","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320931 = Hospital System Supply Identifier | 534145 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 58X32","code_information":[{"code":"Sx00-7105-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320932","type":"LOCAL"},{"code":"534146","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320932 = Hospital System Supply Identifier | 534146 = Lawson ID"}]},{"description":"LINER REV HIP TM NEU LNG 36X58","code_information":[{"code":"Sx00-7105-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"195289","type":"LOCAL"},{"code":"372221","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 195289 = Hospital System Supply Identifier | 372221 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 60X36","code_information":[{"code":"Sx00-7105-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320934","type":"LOCAL"},{"code":"534148","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320934 = Hospital System Supply Identifier | 534148 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 0D 32X60MM","code_information":[{"code":"Sx00-7105-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198402","type":"LOCAL"},{"code":"443654","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 198402 = Hospital System Supply Identifier | 443654 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 60X28","code_information":[{"code":"Sx00-7105-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320933","type":"LOCAL"},{"code":"534147","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320933 = Hospital System Supply Identifier | 534147 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 0D 40X62MM","code_information":[{"code":"Sx00-7105-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198400","type":"LOCAL"},{"code":"443652","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 198400 = Hospital System Supply Identifier | 443652 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 62/64X28","code_information":[{"code":"Sx00-7105-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320935","type":"LOCAL"},{"code":"534149","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320935 = Hospital System Supply Identifier | 534149 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 62/64X32","code_information":[{"code":"Sx00-7105-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320936","type":"LOCAL"},{"code":"534150","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320936 = Hospital System Supply Identifier | 534150 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 62/64X36","code_information":[{"code":"Sx00-7105-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320937","type":"LOCAL"},{"code":"534151","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320937 = Hospital System Supply Identifier | 534151 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 66-70X28","code_information":[{"code":"Sx00-7105-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320938","type":"LOCAL"},{"code":"534152","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320938 = Hospital System Supply Identifier | 534152 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 66-70X32","code_information":[{"code":"Sx00-7105-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320939","type":"LOCAL"},{"code":"534153","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320939 = Hospital System Supply Identifier | 534153 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 66-70X36","code_information":[{"code":"Sx00-7105-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320940","type":"LOCAL"},{"code":"534154","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320940 = Hospital System Supply Identifier | 534154 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 0D 40X66-70","code_information":[{"code":"Sx00-7105-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202085","type":"LOCAL"},{"code":"452181","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 202085 = Hospital System Supply Identifier | 452181 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 72/74X28","code_information":[{"code":"Sx00-7105-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320941","type":"LOCAL"},{"code":"534155","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320941 = Hospital System Supply Identifier | 534155 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 72/74X32","code_information":[{"code":"Sx00-7105-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320942","type":"LOCAL"},{"code":"534156","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320942 = Hospital System Supply Identifier | 534156 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 72/74X36","code_information":[{"code":"Sx00-7105-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320943","type":"LOCAL"},{"code":"534157","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320943 = Hospital System Supply Identifier | 534157 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 72/74X40","code_information":[{"code":"Sx00-7105-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320944","type":"LOCAL"},{"code":"534158","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320944 = Hospital System Supply Identifier | 534158 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 76-80X40","code_information":[{"code":"Sx00-7105-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320948","type":"LOCAL"},{"code":"534162","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320948 = Hospital System Supply Identifier | 534162 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 76-80X36","code_information":[{"code":"Sx00-7105-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320947","type":"LOCAL"},{"code":"534161","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320947 = Hospital System Supply Identifier | 534161 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 76-80X32","code_information":[{"code":"Sx00-7105-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320946","type":"LOCAL"},{"code":"534160","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320946 = Hospital System Supply Identifier | 534160 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 76-80X28","code_information":[{"code":"Sx00-7105-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320945","type":"LOCAL"},{"code":"534159","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320945 = Hospital System Supply Identifier | 534159 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 48X28","code_information":[{"code":"Sx00-7110-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320949","type":"LOCAL"},{"code":"534163","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320949 = Hospital System Supply Identifier | 534163 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 50X28","code_information":[{"code":"Sx00-7110-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320950","type":"LOCAL"},{"code":"534164","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320950 = Hospital System Supply Identifier | 534164 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 52X28","code_information":[{"code":"Sx00-7110-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320951","type":"LOCAL"},{"code":"534165","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320951 = Hospital System Supply Identifier | 534165 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 32X54MM","code_information":[{"code":"Sx00-7110-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202098","type":"LOCAL"},{"code":"452194","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 202098 = Hospital System Supply Identifier | 452194 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 54X28","code_information":[{"code":"Sx00-7110-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320952","type":"LOCAL"},{"code":"534166","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320952 = Hospital System Supply Identifier | 534166 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 56X28","code_information":[{"code":"Sx00-7110-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320953","type":"LOCAL"},{"code":"534167","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320953 = Hospital System Supply Identifier | 534167 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 56X32","code_information":[{"code":"Sx00-7110-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320954","type":"LOCAL"},{"code":"534168","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320954 = Hospital System Supply Identifier | 534168 = Lawson ID"}]},{"description":"IMP HIP ACET LNR LGVTY 58X36","code_information":[{"code":"Sx00-7110-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202100","type":"LOCAL"},{"code":"452196","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 202100 = Hospital System Supply Identifier | 452196 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 58X28","code_information":[{"code":"Sx00-7110-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320955","type":"LOCAL"},{"code":"534169","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320955 = Hospital System Supply Identifier | 534169 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 58X32","code_information":[{"code":"Sx00-7110-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320956","type":"LOCAL"},{"code":"534170","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320956 = Hospital System Supply Identifier | 534170 = Lawson ID"}]},{"description":"IMP HIP ACET LNR10D 60X36MM","code_information":[{"code":"Sx00-7110-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202101","type":"LOCAL"},{"code":"452197","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 202101 = Hospital System Supply Identifier | 452197 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 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62X32","code_information":[{"code":"Sx00-7110-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320961","type":"LOCAL"},{"code":"534175","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320961 = Hospital System Supply Identifier | 534175 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 62X32","code_information":[{"code":"Sx00-7110-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320960","type":"LOCAL"},{"code":"534174","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320960 = Hospital System Supply Identifier | 534174 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 62/64X28","code_information":[{"code":"Sx00-7110-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320959","type":"LOCAL"},{"code":"534173","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320959 = Hospital System Supply Identifier | 534173 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 40X62/64","code_information":[{"code":"Sx00-7110-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202099","type":"LOCAL"},{"code":"452195","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 202099 = Hospital System Supply Identifier | 452195 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 40MM","code_information":[{"code":"Sx00-7110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194975","type":"LOCAL"},{"code":"360636","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 194975 = Hospital System Supply Identifier | 360636 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 36X62/64","code_information":[{"code":"Sx00-7110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202102","type":"LOCAL"},{"code":"452198","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 202102 = Hospital System Supply Identifier | 452198 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 66-70X28","code_information":[{"code":"Sx00-7110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320962","type":"LOCAL"},{"code":"534176","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320962 = Hospital System Supply Identifier | 534176 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 66-70X32","code_information":[{"code":"Sx00-7110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320963","type":"LOCAL"},{"code":"534177","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320963 = Hospital System Supply Identifier | 534177 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 72/74X28","code_information":[{"code":"Sx00-7110-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320964","type":"LOCAL"},{"code":"534178","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320964 = Hospital System Supply Identifier | 534178 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 72/74X32","code_information":[{"code":"Sx00-7110-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320965","type":"LOCAL"},{"code":"534179","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320965 = Hospital System Supply Identifier | 534179 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 72/74X36","code_information":[{"code":"Sx00-7110-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320966","type":"LOCAL"},{"code":"534180","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320966 = Hospital System Supply Identifier | 534180 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 72/74X40","code_information":[{"code":"Sx00-7110-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320967","type":"LOCAL"},{"code":"534181","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320967 = Hospital System Supply Identifier | 534181 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 76-80X28","code_information":[{"code":"Sx00-7110-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320968","type":"LOCAL"},{"code":"534182","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320968 = Hospital System Supply Identifier | 534182 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 76-80X32","code_information":[{"code":"Sx00-7110-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320969","type":"LOCAL"},{"code":"534183","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320969 = Hospital System Supply Identifier | 534183 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 76-80X36","code_information":[{"code":"Sx00-7110-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320970","type":"LOCAL"},{"code":"534184","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320970 = Hospital System Supply Identifier | 534184 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 76-80X40","code_information":[{"code":"Sx00-7110-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320971","type":"LOCAL"},{"code":"534185","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320971 = Hospital System Supply Identifier | 534185 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 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54X32MM","code_information":[{"code":"Sx00-7115-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198399","type":"LOCAL"},{"code":"443651","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 198399 = Hospital System Supply Identifier | 443651 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL TM 56X32","code_information":[{"code":"Sx00-7115-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320973","type":"LOCAL"},{"code":"534187","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320973 = Hospital System Supply Identifier | 534187 = Lawson ID"}]},{"description":"IMP HIP LNR CNSTRN CEM 36X58MM","code_information":[{"code":"Sx00-7115-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202088","type":"LOCAL"},{"code":"452184","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 202088 = Hospital System Supply Identifier | 452184 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL TM 60X36","code_information":[{"code":"Sx00-7115-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320974","type":"LOCAL"},{"code":"534188","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320974 = Hospital System Supply Identifier | 534188 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL TM 62-64X36","code_information":[{"code":"Sx00-7115-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325646","type":"LOCAL"},{"code":"360637","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 325646 = Hospital System Supply Identifier | 360637 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 66/68/70X36","code_information":[{"code":"Sx00-7115-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320975","type":"LOCAL"},{"code":"534189","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320975 = Hospital System Supply Identifier | 534189 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL TM 72/74X36","code_information":[{"code":"Sx00-7115-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320976","type":"LOCAL"},{"code":"534190","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320976 = Hospital System Supply Identifier | 534190 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 76/78/80X36","code_information":[{"code":"Sx00-7115-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320977","type":"LOCAL"},{"code":"534191","type":"LOCAL"}],"standard_charges":[{"gross_charge":9392.0,"discounted_cash":3944.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 320977 = Hospital System Supply Identifier | 534191 = Lawson ID"}]},{"description":"IMP ACET CAGE SHRT FLG RT","code_information":[{"code":"Sx00-7123-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327052","type":"LOCAL"},{"code":"409658","type":"LOCAL"}],"standard_charges":[{"gross_charge":9975.0,"discounted_cash":4189.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 327052 = Hospital System Supply Identifier | 409658 = Lawson ID"}]},{"description":"IMP HIP CAGE SHRT RT 62/64","code_information":[{"code":"Sx00-7123-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321695","type":"LOCAL"},{"code":"534909","type":"LOCAL"}],"standard_charges":[{"gross_charge":9975.0,"discounted_cash":4189.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 321695 = Hospital System Supply Identifier | 534909 = Lawson ID"}]},{"description":"IMP HIP ACET CAGE 55-66","code_information":[{"code":"Sx00-7123-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326741","type":"LOCAL"},{"code":"408186","type":"LOCAL"}],"standard_charges":[{"gross_charge":9975.0,"discounted_cash":4189.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 326741 = Hospital System Supply Identifier | 408186 = Lawson ID"}]},{"description":"IMP ACET CAGE TRBC RT 72-74","code_information":[{"code":"Sx00-7123-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325647","type":"LOCAL"},{"code":"360638","type":"LOCAL"}],"standard_charges":[{"gross_charge":9975.0,"discounted_cash":4189.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 325647 = Hospital System Supply Identifier | 360638 = Lawson ID"}]},{"description":"IMP HIP CAGE SHRT RT 76/78/80","code_information":[{"code":"Sx00-7123-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321696","type":"LOCAL"},{"code":"534910","type":"LOCAL"}],"standard_charges":[{"gross_charge":9975.0,"discounted_cash":4189.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 321696 = Hospital System Supply Identifier | 534910 = Lawson ID"}]},{"description":"IMP HIP CAGE SHRT LT 56/58/60","code_information":[{"code":"Sx00-7124-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321697","type":"LOCAL"},{"code":"534911","type":"LOCAL"}],"standard_charges":[{"gross_charge":9975.0,"discounted_cash":4189.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 321697 = Hospital System Supply Identifier | 534911 = Lawson ID"}]},{"description":"IMP HIP CAGE SHRT LT 62/64","code_information":[{"code":"Sx00-7124-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321698","type":"LOCAL"},{"code":"534912","type":"LOCAL"}],"standard_charges":[{"gross_charge":9975.0,"discounted_cash":4189.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 321698 = Hospital System Supply Identifier | 534912 = Lawson ID"}]},{"description":"IMP HIP CAGE SHRT LT 66/68/70","code_information":[{"code":"Sx00-7124-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321699","type":"LOCAL"},{"code":"534913","type":"LOCAL"}],"standard_charges":[{"gross_charge":9975.0,"discounted_cash":4189.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 321699 = Hospital System Supply Identifier | 534913 = Lawson ID"}]},{"description":"IMP HIP CAGE SHRT LT 72/74","code_information":[{"code":"Sx00-7124-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321700","type":"LOCAL"},{"code":"534914","type":"LOCAL"}],"standard_charges":[{"gross_charge":9975.0,"discounted_cash":4189.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 321700 = Hospital System Supply Identifier | 534914 = Lawson ID"}]},{"description":"IMP HIP SHELL TM SHRT CAGE LT","code_information":[{"code":"Sx00-7124-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326914","type":"LOCAL"},{"code":"402766","type":"LOCAL"}],"standard_charges":[{"gross_charge":9975.0,"discounted_cash":4189.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 326914 = Hospital System Supply Identifier | 402766 = Lawson ID"}]},{"description":"IMP HIP CAGE LNG RT 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7859-10","code_information":[{"code":"Sx00-7859-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145635","type":"LOCAL"},{"code":"203792","type":"LOCAL"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":223.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 145635 = Hospital System Supply Identifier | 203792 = Lawson ID"}]},{"description":"VERSYS DISTAL CENTRALIZER 11MM","code_information":[{"code":"Sx00-7859-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"852988","type":"LOCAL"},{"code":"0005213","type":"LOCAL"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":223.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 852988 = Hospital System Supply Identifier | 0005213 = Lawson ID"}]},{"description":"IMP HIP CNTRLZR DST VS 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7859-13","code_information":[{"code":"Sx00-7859-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145638","type":"LOCAL"},{"code":"203795","type":"LOCAL"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":223.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 145638 = Hospital System Supply Identifier | 203795 = Lawson ID"}]},{"description":"IMP DISTAL CENT 7859-14","code_information":[{"code":"Sx00-7859-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145639","type":"LOCAL"},{"code":"203796","type":"LOCAL"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":223.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 145639 = Hospital System Supply Identifier | 203796 = Lawson ID"}]},{"description":"IMP DISTAL CENT 7859-15","code_information":[{"code":"Sx00-7859-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167809","type":"LOCAL"},{"code":"203797","type":"LOCAL"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":223.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 167809 = Hospital System Supply Identifier | 203797 = Lawson ID"}]},{"description":"IMP DISTAL CENT 7859-16","code_information":[{"code":"Sx00-7859-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145640","type":"LOCAL"},{"code":"203798","type":"LOCAL"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":223.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 145640 = Hospital System Supply Identifier | 203798 = Lawson ID"}]},{"description":"IMP DISTAL CENT 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260","code_information":[{"code":"Sx00-8114-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321242","type":"LOCAL"},{"code":"534456","type":"LOCAL"}],"standard_charges":[{"gross_charge":14588.0,"discounted_cash":6126.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 321242 = Hospital System Supply Identifier | 534456 = Lawson ID"}]},{"description":"IMP HIP FEM STEM CPT SZ5XEXT","code_information":[{"code":"Sx00-8114-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305341","type":"LOCAL"},{"code":"524287","type":"LOCAL"}],"standard_charges":[{"gross_charge":5922.0,"discounted_cash":2487.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 305341 = Hospital System Supply Identifier | 524287 = Lawson ID"}]},{"description":"IMP HIP FEM STEM CPT SZ5 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HUM","code_information":[{"code":"Sx00-8400-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"744116","type":"LOCAL"},{"code":"456596","type":"LOCAL"}],"standard_charges":[{"gross_charge":1323.01,"discounted_cash":555.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 744116 = Hospital System Supply Identifier | 456596 = Lawson ID"}]},{"description":"KIT ARTICULATION SZ 4","code_information":[{"code":"Sx00-8400-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"744117","type":"LOCAL"},{"code":"456597","type":"LOCAL"}],"standard_charges":[{"gross_charge":4701.99,"discounted_cash":1974.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 744117 = Hospital System Supply Identifier | 456597 = Lawson ID"}]},{"description":"KIT ARTICULATION SZ 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28MM","code_information":[{"code":"Sx00-8700-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"722290","type":"LOCAL"},{"code":"733737","type":"LOCAL"}],"standard_charges":[{"gross_charge":11384.33,"discounted_cash":4781.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 722290 = Hospital System Supply Identifier | 733737 = Lawson ID"}]},{"description":"IMP HIP LNR EE 28X44MM","code_information":[{"code":"Sx00-8751-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"181650","type":"LOCAL"},{"code":"453449","type":"LOCAL"}],"standard_charges":[{"gross_charge":3756.5,"discounted_cash":1577.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 181650 = Hospital System Supply Identifier | 453449 = Lawson ID"}]},{"description":"IMP HIP LNR LGVTY NTRL 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65CM","code_information":[{"code":"Sx00000004165","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"},{"code":"1444660","type":"LOCAL"},{"code":"1096211","type":"LOCAL"}],"standard_charges":[{"gross_charge":41580.0,"discounted_cash":17463.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 1444660 = Hospital System Supply Identifier | 1096211 = Lawson ID"}]},{"description":"LINE ASPIR/ANTICOAG 3/8IN","code_information":[{"code":"Sx00000004197","type":"CDM"},{"code":"272","type":"RC"},{"code":"795636","type":"LOCAL"},{"code":"775105","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.54,"discounted_cash":340.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 795636 = Hospital System Supply Identifier | 775105 = Lawson ID"}]},{"description":"GWIRE EZGLIDR .035X150CM STRL","code_information":[{"code":"Sx000000041BX","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"198527","type":"LOCAL"},{"code":"443821","type":"LOCAL"}],"standard_charges":[{"gross_charge":481.47,"discounted_cash":202.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 198527 = Hospital System Supply Identifier | 443821 = Lawson ID"}]},{"description":"CLIP LIG HORZ TI LG","code_information":[{"code":"Sx00000004200","type":"CDM"},{"code":"KT","type":"RC"},{"code":"18318","type":"LOCAL"},{"code":"203539","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.48,"discounted_cash":32.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 18318 = Hospital System Supply Identifier | 203539 = Lawson ID"}]},{"description":"HEMOCLIP TI HORIZON LG 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5.5X145MM","code_information":[{"code":"Sx00000004250","type":"CDM"},{"code":"272","type":"RC"},{"code":"176565","type":"LOCAL"},{"code":"221917","type":"LOCAL"}],"standard_charges":[{"gross_charge":8951.75,"discounted_cash":3759.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 176565 = Hospital System Supply Identifier | 221917 = Lawson ID"}]},{"description":"SET BOWL CELL SAVER 55","code_information":[{"code":"Sx00000004250","type":"CDM"},{"code":"272","type":"RC"},{"code":"400316","type":"LOCAL"},{"code":"636996","type":"LOCAL"}],"standard_charges":[{"gross_charge":1137.74,"discounted_cash":477.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 400316 = Hospital System Supply Identifier | 636996 = Lawson ID"}]},{"description":"SET BOWL CELL SAVER 125","code_information":[{"code":"Sx00000004251","type":"CDM"},{"code":"272","type":"RC"},{"code":"400317","type":"LOCAL"},{"code":"636997","type":"LOCAL"}],"standard_charges":[{"gross_charge":1137.74,"discounted_cash":477.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 400317 = Hospital System Supply Identifier | 636997 = Lawson ID"}]},{"description":"SET BOWL XTRA 175ML","code_information":[{"code":"Sx00000004252","type":"CDM"},{"code":"272","type":"RC"},{"code":"795637","type":"LOCAL"},{"code":"775106","type":"LOCAL"}],"standard_charges":[{"gross_charge":1137.74,"discounted_cash":477.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 795637 = Hospital System Supply Identifier | 775106 = Lawson ID"}]},{"description":"SET BOWL CELL SAVER 225","code_information":[{"code":"Sx00000004253","type":"CDM"},{"code":"272","type":"RC"},{"code":"354024","type":"LOCAL"},{"code":"591212","type":"LOCAL"}],"standard_charges":[{"gross_charge":1137.74,"discounted_cash":477.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 354024 = Hospital System Supply Identifier | 591212 = Lawson ID"}]},{"description":"SET CELLSAVER XTRA TX/225CC","code_information":[{"code":"Sx00000004257","type":"CDM"},{"code":"272","type":"RC"},{"code":"454360","type":"LOCAL"},{"code":"575624","type":"LOCAL"}],"standard_charges":[{"gross_charge":1811.24,"discounted_cash":760.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 454360 = Hospital System Supply Identifier | 575624 = Lawson ID"}]},{"description":"RESERVOIR BLD COLL XRES B","code_information":[{"code":"Sx00000004259","type":"CDM"},{"code":"272","type":"RC"},{"code":"795638","type":"LOCAL"},{"code":"775107","type":"LOCAL"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":223.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 795638 = Hospital System Supply Identifier | 775107 = Lawson ID"}]},{"description":"SET PROC BX/55","code_information":[{"code":"Sx00000004261","type":"CDM"},{"code":"272","type":"RC"},{"code":"795639","type":"LOCAL"},{"code":"775108","type":"LOCAL"}],"standard_charges":[{"gross_charge":1958.77,"discounted_cash":822.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 795639 = Hospital System Supply Identifier | 775108 = Lawson ID"}]},{"description":"SET PROC BX/125","code_information":[{"code":"Sx00000004262","type":"CDM"},{"code":"272","type":"RC"},{"code":"795640","type":"LOCAL"},{"code":"775109","type":"LOCAL"}],"standard_charges":[{"gross_charge":1958.77,"discounted_cash":822.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 795640 = Hospital System Supply Identifier | 775109 = Lawson ID"}]},{"description":"SET PROC BX/175","code_information":[{"code":"Sx00000004263","type":"CDM"},{"code":"272","type":"RC"},{"code":"795641","type":"LOCAL"},{"code":"775110","type":"LOCAL"}],"standard_charges":[{"gross_charge":1958.77,"discounted_cash":822.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 795641 = Hospital System Supply Identifier | 775110 = Lawson ID"}]},{"description":"SET PROC BX/225","code_information":[{"code":"Sx00000004264","type":"CDM"},{"code":"272","type":"RC"},{"code":"795642","type":"LOCAL"},{"code":"775111","type":"LOCAL"}],"standard_charges":[{"gross_charge":1845.77,"discounted_cash":775.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 795642 = Hospital System Supply Identifier | 775111 = Lawson ID"}]},{"description":"SET COLL BX","code_information":[{"code":"Sx00000004265","type":"CDM"},{"code":"272","type":"RC"},{"code":"795643","type":"LOCAL"},{"code":"775112","type":"LOCAL"}],"standard_charges":[{"gross_charge":839.47,"discounted_cash":352.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 795643 = Hospital System Supply Identifier | 775112 = Lawson ID"}]},{"description":"SET COLL TX CARDIO","code_information":[{"code":"Sx00000004266","type":"CDM"},{"code":"272","type":"RC"},{"code":"795644","type":"LOCAL"},{"code":"775113","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.8,"discounted_cash":358.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 795644 = Hospital System Supply Identifier | 775113 = Lawson ID"}]},{"description":"SET COLL BX CARDIO","code_information":[{"code":"Sx00000004267","type":"CDM"},{"code":"272","type":"RC"},{"code":"795645","type":"LOCAL"},{"code":"775114","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.8,"discounted_cash":358.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 795645 = Hospital System Supply Identifier | 775114 = Lawson ID"}]},{"description":"HOLDER RESERVOIR PERFUSION CARDIOTOMY BLOOD COLLECTION XRES 04272","code_information":[{"code":"Sx00000004272","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531023","type":"LOCAL"},{"code":"1104783","type":"LOCAL"}],"standard_charges":[{"gross_charge":6497.94,"discounted_cash":2729.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 1531023 = Hospital System Supply Identifier | 1104783 = Lawson ID"}]},{"description":"RESERVOIR BLD COLL XRES B 120","code_information":[{"code":"Sx00000004275","type":"CDM"},{"code":"272","type":"RC"},{"code":"795647","type":"LOCAL"},{"code":"775116","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.22,"discounted_cash":243.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 795647 = Hospital System Supply Identifier | 775116 = Lawson ID"}]},{"description":"SET COLL BX CARDIO 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04359","code_information":[{"code":"Sx00000004359","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531026","type":"LOCAL"},{"code":"1104818","type":"LOCAL"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":223.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 1531026 = Hospital System Supply Identifier | 1104818 = Lawson ID"}]},{"description":"COLLECTION SET CORONARY PERFUSION TX XTRA 04360","code_information":[{"code":"Sx00000004360","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531020","type":"LOCAL"},{"code":"1104756","type":"LOCAL"}],"standard_charges":[{"gross_charge":839.47,"discounted_cash":352.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 1531020 = Hospital System Supply Identifier | 1104756 = Lawson ID"}]},{"description":"PROCEDURE SET CORONARY PERFUSION BX BOWL XTRA 04361 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04365","code_information":[{"code":"Sx00000004365","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531021","type":"LOCAL"},{"code":"1104779","type":"LOCAL"}],"standard_charges":[{"gross_charge":839.47,"discounted_cash":352.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 1531021 = Hospital System Supply Identifier | 1104779 = Lawson ID"}]},{"description":"COLLECTION SET CORONARY PERFUSION TX CARDIO XTRA 04366","code_information":[{"code":"Sx00000004366","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531003","type":"LOCAL"},{"code":"1104794","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.8,"discounted_cash":358.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 1531003 = Hospital System Supply Identifier | 1104794 = Lawson ID"}]},{"description":"COLLECTION SET CORONARY PERFUSION BX CARDIO XTRA 04367","code_information":[{"code":"Sx00000004367","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531017","type":"LOCAL"},{"code":"1104745","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.8,"discounted_cash":358.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 1531017 = Hospital System Supply Identifier | 1104745 = Lawson ID"}]},{"description":"BAG CORONARY PERFUSION WASTE WB10 XTRA 04369 10L","code_information":[{"code":"Sx00000004369","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531028","type":"LOCAL"},{"code":"1104827","type":"LOCAL"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":223.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 1531028 = Hospital System Supply Identifier | 1104827 = Lawson ID"}]},{"description":"RESERVOIR SET CORONARY PERFUSION B BLOOD XTRA XRES 04375 120UM","code_information":[{"code":"Sx00000004375","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531006","type":"LOCAL"},{"code":"1104645","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.22,"discounted_cash":243.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 1531006 = Hospital System Supply Identifier | 1104645 = Lawson ID"}]},{"description":"COLLECTION SET CORONARY PERFUSION B GROSS FILTER XTRA 04376 120UM","code_information":[{"code":"Sx00000004376","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531005","type":"LOCAL"},{"code":"1104625","type":"LOCAL"}],"standard_charges":[{"gross_charge":1305.85,"discounted_cash":548.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TGS LOCATION | 1531005 = Hospital System Supply Identifier | 1104625 = Lawson ID"}]},{"description":"COLLECTION SET CORONARY PERFUSION B CARDIO GROSS XTRA 04377 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